Reconstruction of perineoscrotal defects in Fournier's gangrene with pedicle anterolateral thigh perforator flap

Background: Fournier's gangrene is an acute and potentially lethal necrotizing fasciitis that involves the scrotum and perineum. This disease can result in the extensive loss of skin and soft tissues of the perineoscrotal area with exposure of the testes. To reconstruct the large defects of scrotal and perineal remains a surgical challenge. Methods: Between January 2008 and December 2012, 26 patients were admitted with a diagnosis of Fournier's gangrene. The Division of Plastic and Reconstructive Surgery at our hospital was consulted about patients who needed reconstructive procedures after initial debridement was performed in the Division of Colorectal Surgery or the Division of Urology. Of the 26 patients, 10 patients with large perineoscrotal defects who underwent the reconstructive surgery using pedicle anterolateral thigh (ALT) perforator flaps were enrolled in this series. Results: We carried out the perineoscrotal reconstruction in these 10 patients using the pedicled ALT perforator flaps. They were all male with a mean age of 59.1 years (ranged from 39 to 82 years). The size of the flaps ranged from 72 to 198 cm². All flaps survived completely but one hematoma was noticed postoperatively. All patients mobilized well with no limitation of motion, and the scrotal contour appeared to be natural. Conclusion: Early debridement and wound coverage in Fournier's gangrene are mandatory to allow patients to return to normal life. Pedicle ALT perforator flaps provide pliable and reliable soft-tissue coverage for large perineoscrotal defects with adequate contour that result in satisfactory function and cosmesis.