Unilateral gracilis myofasciocutaneous advancement flap for single stage reconstruction of scrotal and perineal defects

Summary 

Background

Extensive defects of the perineal area, with exposure of the testes, are difficult to reconstruct. Numerous reconstruction methods are available, but few provide us with an aesthetically acceptable, thin and pliable cover. The gracilis myocutaneous flap had the disadvantage of an unreliable skin paddle since McCraw's original description. Our method of using a longitudinally orientated gracilis myofasciocutaneous flap with wide incorporation of the perigracilis fascia, provided us a large reliable cutaneous territory and allowed us to repair extensive perineal defects in one single operation.

Methods

Eight patients treated for Fournier's gangrene between 2003 and 2005 were enrolled in the study. All patients underwent early, aggressive surgical debridement followed by surgical reconstruction with a gracilis myofasciocutaneous flap.

Results

The size of the defect ranged from 12cm×7cm to 30cm×15cm. Diverting colostomy was performed in six of the eight patients. All patients recuperated well with good coverage of the defects. No wound dehiscence due to excessive tension was seen. Haematoma developed in one patient. One patient developed an abscess in the distal part of the donor thigh three months after the initial flap coverage.

Conclusion

Gracilis myofasciocutaneous advancement flap provides a good cover for the perineal defect with testicular exposure. It is technically easy and has favourable functional and aesthetic results. It allows the surgeon the ability to reconstruct the perineal and scrotal defects in one single stage.

Keywords: Gracilis myofasciocutaneous flap, Fournier's gangrene, Scrotal reconstruction