title: Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene.
abstract: Fournier's gangrene is an acute and potentially lethal necrotizing fasciitis that can lead to extensive defects of the perineoscrotal area and lower abdominal wall as well. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Local perforator pedicle flaps and muscle flaps can be employed and combined for such a reconstruction. In this report we present a case of reconstruction of a massive perineoscrotal and upper medial thigh defect because of Fournier's gangrene using a bilateral pedicle anterolateral thigh (ALT) flap and sartorius muscle flap. A 61 year-old male who suffered from Fournier's gangrene resulted in a perineal, scrotal, and medial thigh defect of 27 × 30 cm2with exposure of the femoral vessels. A bilateral pedicle ALT flap measuring 30 × 9 cm2based on two perforators and a bilateral sartorius muscle flap were harvested for soft tissue defect reconstruction and inguinal vessels coverage, respectively. The flaps survived completely, with no recipient or donor site morbidity. The length of follow-up was 6 months and was uneventful. A bilateral pedicle ALT flap combined with bilateral sartorius flap may be considered as a valid and safe option for an extensive inguinal and perineoscrotal reconstruction in selected cases. © 2016 Wiley Periodicals, Inc. Microsurgery 37:669-673, 2017.
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Mario F
authors.initials: MF
authors.lastname: Scaglioni
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Fakin
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Andrè A
authors.initials: AA
authors.lastname: Barth
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Giovanoli
mesh_terms: D005500:Follow-Up Studies; D018934:Fournier Gangrene / Q000175:diagnosis / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D061525:Perforator Flap / Q000098:blood supply / Q000637:transplantation*; D010502:Perineum / Q000473:pathology / Q000601:surgery; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D012611:Scrotum / Q000473:pathology / Q000601:surgery; D012720:Severity of Illness Index; D013848:Thigh / Q000601:surgery; D020858:Tissue and Organ Harvesting; D014945:Wound Healing / Q000502:physiology*