Penoscrotal reconstruction with gracilis muscle flap and internal pudendal artery perforator flap transposition

Abstract

OBJECTIVE: Extensive defects of the perineal area, with exposure of the testes, are difficult to reconstruct. For the reconstruction of these defects, we applied gracilis muscle flap combined with pudendal artery perforator fasciocutaneous flap, which provided us a reliable cutaneous flap and allowed us to cover exposed testes with sufficient muscular volume.

METHODS: We retrospectively analyzed 7 patients from 2004-2011 whose penoscrotal defects had been reconstructed using gracilis muscle flap and an internal pudendal artery perforator flap. Six had Fournier's gangrene and 1 had extramammary Paget's disease. We examined characteristics of the patients, preoperative management, operative procedure, and their clinical courses.

RESULTS: All flaps survived during the entire follow-up periods. The mean width of the defects was 10.14 cm and the mean length was 9.29 cm. The width of the fasciocutaneous flap was approximately 6-10 cm, whereas the length ranged from 10-15 cm. The reconstructed areas were in good functional and esthetic conditions.

CONCLUSION: The combination of the gracilis muscle flap and the internal pudendal artery perforator fasciocutaneous flap provides pliable and reliable soft tissue coverage for extensive penoscrotal defects with adequate bulkiness and minimal donor site morbidity.