title: Reconstruction of perineoscrotal defects in Fournier's gangrene with pedicle anterolateral thigh perforator flap.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Chin-Ta
authors: CT
authors: Lin
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Shun-Cheng
authors: SC
authors: Chang
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Shyi-Gen
authors: SG
authors: Chen
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Yuan-Sheng
authors: YS
authors: Tzeng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement / Q000379:methods; D005500:Follow-Up Studies; D018934:Fournier Gangrene / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap; D010502:Perineum; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012611:Scrotum; D013848:Thigh; D016896:Treatment Outcome
keywords: 
  Fournier's gangrene; pedicle anterolateral thigh flap; perineoscrotal defect; reconstruction