Limberg Flap Reconstruction For Scrotal Defects After Fournier's Gangrene
Mehmet Emin Cem Yildirim, M.D.1, Serhat Yarar, M.D.2, Mehmet Dadaci, M.D.1, Bilsev Ince, M.D.1.
1Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Konya, Turkey, 2Konya Numune Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Konya, Turkey.
PURPOSE: Fournier gangrene (FG) is rarely encountered, but is a necrotizing fasciitis affecting principally skin and subcutaneous tissues of the genital region and abdominal wall. Sepsis presentation is also highly possible, unless affected patients are treated aggressively. Multiple organ failure is the main cause of mortality; hemodynamic resuscitation, broad-spectrum antibiotics, and surgical debridement should be included in the urgent treatment approach.Local fasciocutaneous flaps, split thickness skin grafts, and several muscle flaps were defined in the literature for scrotal reconstruction after multiple debridement procedures. However, we have not come across a case series including unilateral or bilateral Limberg flaps in scrotal repair. In this study, we used unilateral or bilateral Limberg flaps for scrotal reconstruciton after FG. METHODS: Given 14 male patients with scrotal defects after multiple debridements, they were included in the study. The mean age was 61 (min. 47-max. 77). Patients with defects of less than 50% of the scrotal surface, as well as irregular follow-ups, were not included in the study.
Surgical Technique:Providing proper wound ground after consecutive debridements and regression of inflammation, patients underwent elective defect repair surgeries. A pedicule of flap was designed on the thigh’s anterior side, so it was planned medially on the proximal third of the thigh (according to defect size). Suprafascial harvest of the flap was applied as a Limberg flap execution. Bilateral Limberg flaps harvested from both thighs were placed in the midline, and sutured to each other to repair double-sided defects in the scrotal area (Fig. 1). A unilateral Limberg flap was sutured to the counter side, so that scrotal tissue could be released in 2 patients with unilateral total and counter lateral partial defects. Fat tissue was trimmed in cases of excess. Tension-free flap transposition was obtained in all cases. Donor areas were closed following the hemovac drain placement to them.
RESULTS: Exposition of both testicles was presented in 9 cases. Five patients had total exposure of 1 testicle, with partial exhibiton of the other one. Four patients had Diabetes Mellitus (DM) as a comorbid desease and 1 patient was diagnosed with spontaneous lung malignancy. Seroma and dehiscence were encountered in 3 patients during postoperative follow-ups. After the wound care period, the flaps were revised and defect areas were repaired again. The operation took 1.5 hours for a bilateral Limberg flap application, without any partial or total necroses postoperatively.
CONCLUSION: In summary, Limberg flap execution for scrotal reconstruction following FG has important benefits compared to pedicle flaps: they are easily harvested, involve tension-free repair, and have favorable cosmetic results. Consequently, a satisfying outcome is available after applying a Limberg flap (designed from the thigh) to reconstruct scrotal defects.
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