title: Fournier's gangrene - delayed pedicle flap based upon the anterior abdominal wall.
abstract: BACKGROUND
  Fournier's gangrene is a poly-microbial necrotizing fasciitis that involves the perineum and/or external genitalia. Urgent surgical debridement is well recognized as essential acute treatment yet unique challenges arise for plastic surgical reconstruction to obtain a complete functional recovery. This case describes a successful delayed pedicle flap repair based upon the anterior abdominal wall.
  
  
  METHODS
  A 24 year old man was admitted to ICU ten days after elective circumcision with Fournier's gangrene. He underwent a number of surgical debridements, and was referred for plastic surgical management. He had penile reconstruction using a random pattern abdominal flap, which was performed as a three stage procedure including flap vascular delay technique.
  
  
  CONCLUSIONS
  Perineal and penile skin loss can be significant and is difficult to repair. Various techniques have been used to reconstruct lost tissue: skin grafts, transposition of the testes and spermatic cords to the thigh, flaps, and other types of pediculated myocutaneous flaps. Muscle flap reconstruction provides an environment that allows for complete regeneration of the urethral epithelium but is bulky and unsightly. Skin grafts contract and may produce painful and dysfunctional reconstructions. This novel technique produces a functional, and aesthetic reconstruction.
  
  
  CONCLUSIONS
  Penile skin recovery following Fournier's gangrene recovery is problematic. This case demonstrates the functionality of a delayed flap repair using the anterior abdominal wall.
authors.affiliation: Department of Urology, University of Melbourne, Austin Hospital, Melbourne, Australia.
authors.forename: Ania
authors.initials: A
authors.lastname: Sliwinski
authors.affiliation: Department of Urology, University of Melbourne, Austin Hospital, Melbourne, Australia.
authors.forename: Liam E
authors.initials: LE
authors.lastname: Kavanagh
authors.affiliation: Department of Urology, University of Melbourne, Austin Hospital, Melbourne, Australia.
authors.forename: Damien
authors.initials: D
authors.lastname: Bolton
authors.affiliation: Department of Urology, University of Melbourne, Austin Hospital, Melbourne, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
authors.affiliation: Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: John G
authors.initials: JG
authors.lastname: Crock
mesh_terms: D034861:Abdominal Wall; D002944:Circumcision, Male / Q000009:adverse effects; D018934:Fournier Gangrene / Q000601:surgery*; D006801:Humans; D008297:Male; D010409:Penile Diseases / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012611:Scrotum / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000637:transplantation*; D060053:Transplant Donor Site; D016896:Treatment Outcome; D055815:Young Adult