Simultaneous deep inferior epigastric and bilateral anterolateral thigh perforator flap reconstruction of an extended perineoscrotal defect in Fournier's gangrene: A case report
Simultaneous deep inferior epigastric and bilateral anterolateral thigh perforator flap reconstruction of an extended perineoscrotal defect in Fournier's gangrene: A case report
复制标题
DOI：
10.1002/micr.30409
复制
发表时间：
2019-03-01
期刊：
影响因子：
2.1
通讯作者：
Kiyoshima, Keijiro
中科院分区：
文献类型：
--
作者：
Kadota, Hideki;Momii, Kenta;Kiyoshima, Keijiro
Fournier坏疽是一种累及会阴和外生殖器的致死性坏死性筋膜炎。我们报告一位52岁的男性患者，他患有Fournier坏疽，并接受三个带蒂穿支皮瓣重建广泛的会阴阴囊缺损。三次清创手术导致36 x 18 cm的皮肤和软组织缺损，涉及会阴、阴囊、腹股沟、大腿内侧、臀部和肛周周围区域，并且导致源自这些位置的穿通动脉无法进行重建。我们使用左侧腹壁下深动脉穿支（DIEP）（29 × 8 cm）和双侧股前外侧穿支（ALT）皮瓣（35 × 8 cm和22 × 7 cm）修复了缺损。皮瓣在无张力的情况下到达缺损处，并且在没有皮肤移植物的情况下成功覆盖了缺损。术后除DIEP皮瓣尖端有一小部分表皮坏死外，无其他并发症发生。术后9个月，患者未出现肠功能或髋关节运动受损。重建的会阴皮肤也没有撕脱或溃疡，愈合的伤口和供区的美容外观令人满意。这三个穿支皮瓣的组合使我们能够获得满意的结果，同时避免皮肤移植。
Fournier's gangrene is lethal necrotizing fasciitis that involves the perineum and external genitalia. We describe the case of a 52-year-old man with Fournier's gangrene who underwent reconstruction of an extensive perineoscrotal defect using three pedicled perforator flaps. Three debridement procedures resulted in a skin and soft tissue defect of 36x18cm involving the perineum, scrotum, groin, medial thigh, buttocks, and circumferential perianal area and left the perforating arteries originating from these locations unavailable for reconstruction. We repaired the defect using left deep inferior epigastric artery perforator (DIEP) (29x8 cm) and bilateral anterolateral thigh perforator (ALT) flaps (35x8 cm and 22x7 cm). The flaps reached the defect without tension, and the defect was successfully covered without a skin graft. No postoperative complications occurred except for epidermal necrosis involving a tiny part of the DIEP flap tip. Nine months postoperatively, the patient experienced no impairment of bowel function or hip joint movement. There was also no avulsion or ulceration of the reconstructed perineal skin, and the cosmetic appearances of the healed wound and donor site were satisfactory. The combination of these three perforator flaps enabled us to achieve a satisfactory outcome while avoiding skin grafts.