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 12 cm×7 cm to 30 cm×15 cm. 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
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References
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Article info
Publication history
Published online: February 26, 2007
Accepted:
September 20,
2006
Received:
June 6,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Re: ‘Unilateral gracilis myofasciocutaneous advancement flap for single stage reconstruction of scrotal and perineal defects’Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 61Issue 6
- PreviewI read with interest Hsu et al.'s series of eight patients with Fournier's gangrene reconstructed with gracils myofasciocutaneous advancement flaps.1 They cite their advancement flap as superior to skin grafting techniques – in that skin grafts tend to contract, have patchy ‘take’, and may heal poorly. In my experience of dealing with a similar number of patients with Fournier's gangrene, I have found skin grafting to be well suited for wound closure. The patients' described in the paper are elderly or have significant co-morbid conditions – reasons for choosing a simple reconstruction such as a meshed skin graft rather than a myofasciocutaneous flap.
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- Response to Re: ‘Unilateral gracilis myofasciocutaneous advancement flap for single stage reconstruction of scrotal and perineal defects’Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 61Issue 6
- PreviewIt is our pleasure to be invited to respond to the letter regarding our recently published paper entitled ‘Unilateral gracilis myofasciocutaneous advancement flap for single stage reconstruction of scrotal and perineal defects’.1 Theoretically, all kinds of wounds could be reconstructed with skin grafts as if the wound beds are able to provide adequate perfusion for imbibition to occur. However, the functional and cosmetic outcomes limit its use. Skin grafts are not as durable as the gracilis myofasciocutaneous flap.
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