BİLATERAL MEDİAL UYLUK PERFORATÖR FLEBİ İLE FOURNİER GANGRENİ ONARIMI

Year 2008, Volume: 16 Issue: 3, 130 - 133, 01.12.2008

Semra Karşıdağ Mahmut Ulvi Kayalı Arzu Özcan Kemal Uğurlu Leyla Türkoğlu Kılınç Lütfü Baş

Abstract

Fournier gangreni, karışık aerobik ve anaerobik mikroorganizmaların yol açtığı genital bölgenin nekotizan fasiitidir. Fonksiyonel ve estetik açıdan iyi sonuç alabilmek için, testislerin açığa çıktığı durumlarda üzerlerinin sağlıklı bir dokuyla örtülmesi gereklidir. Uyluk medial bölgeden hazırlanan çeşitli flepler örtüm için kullanılmıştır. Daha iyi şekillendirilebilme olanağı sağladığı için, medial uyluk bölgesinden hazırlanan perforatör tabanlı lokal flepler bu bölgenin rekonstrüksiyonunda önemli bir seçenektir. Kliniğimizde fournier gangrenine sekonder her iki testisin ve perinenin geniş defekti nedeniyle 45 yaşında erkek hastaya seri debridmanlar sonrası, her iki uyluk medial yüzden hazırlanan medial sirkumfleks femoral arter perforatör bazlı lokal flepler yardımı ile onarım uygulandı. Flepte erken dönemde parsiyel veya total nekroz görülmedi. Hastada postoperatif enfeksiyon, akıntı gibi geç komplikasyonlar görülmedi. Perforatör tabanlı medial uyluk fleplerinin, iyi şekillendirmeye olanak sağlamaları, lokal olarak hazırlanabilmeleri, ince kolay bükülebilir yapısı ile genital bölge defektlerinin onarımında uygun bir seçenek olduğunu düşünmekteyiz.

Keywords

Fournier gangreni, bilateral, medial sirkumfleks femoral arter perforatör flebi

FOURNIER GANGRENE RECONSTRUCTION USING BILATERAL MEDIAL CIRCUMFLEX FEMORAL ARTERY PERFORATOR FLAP

Abstract

Fournier gangrene is a necrotizing fasciitis that caused by both aerobic and anaerobic organisms and also spreads to all genitalia plans . To obtain both functional and aesthetic results, exposed testicles should be covered with healthy tissue. In literature there were lots of flap were harvested from medial tigh. Medial circumflex femoral artery perforator flap is very important issue cause of more pliable among the locoregional flaps. In our clinic we have treated a 45 year-old non-diabetic patient who sufferred from the fournier gangrene which spreaded along deep fascial planes of scrotum and perineum with bilateral local medial circumflex femoral artery perforator (MCFAP) flap based on musculocutaneous perforators of the gracilis muscle after serial debridments. There was no partial or total necrosis in the early postoperative period. The authors have reported that the medial circumflex femoral artery perforator (MCFAP) flap based on musculocutaneous perforators is a convenient, usually available, relatively thin and pliable local flap solution for a reconstruction of genital defects.

Keywords

fournier gangrene, bilateral, medial circumflex femoral artery perforator flap

References

• 1. Snyder N IV, Gould LJ. Scrotal and penile reconstruction using the vacuum-assisted closure device. Can J Plast Surg. 2005;13:205–206.
• 2. Kilic A, Aksoy Y. Fournier’s gangrene: etiology, treatment, and complications. Ann Plast Surg 2001;47:523–527.
• 3. Spirnak JP, Resnick MI, Hampel N, Persky L. Fournier’s gangrene: report of 20 patients. J Urol. 1984;131:289–291.
• 4. Jones RB, Hirschmann JV, Brown GS, Tremann JA. Fournier’s syndrome. Necrotizing subcutaneous infection of the male genitalia. J Urol. 1979;122:279–282.
• 5. Balakrishnan C. Scrotal avulsion: a new technique of reconstruction by split-skin graft. Br J Plast Surg. 1956;9:38-42.
• 6. d’Alessio E, Rossi F, d’Alessio R. Reconstruction in traumatic avulsion of penile and scrotal skin. Ann Plast Surg. 1982;9:120 –124.
• 7. Hirshowitz B, Peretz BA. Bilateral superomedial thigh flaps for primary reconstruction of scrotum and vulva. Ann Plast Surg. 1982;8:390 –396.
• 8. Tiwari IN, Seth HP, Mehdiratta KS. Reconstruction of the scrotum by thigh flaps. Plast Reconstr Surg. 1980;66:605–606.
• 9. Maharaj D, Naraynsingh V, Perry A, et al. The scrotal reconstruction using the “Singapore sling”. Plast Reconstr Surg. 2002;110:203–205.
• 10. Westfall CT, Keller HB. Scrotal reconstruction utilizing bilateral gracilis myocutaneous flaps. Plast Reconstr Surg. 1981;68:945–947.
• 11. Hallock GG.Scrotal reconstruction following fournier gangrene using the medial circumflex femoral artery perforator flap. Ann Plast Surg 2006;57:333–335.
• 12. Haertsch PA. The blood supply to the skin of the leg: post-mortem investigation. Br J Plast Surg.1981;34:470.
• 13. Har-Shai Y, Hirschowitz B, Merovietch A, et al. Blood supply and innervation of the superior medial thigh flap employed in one stage reconstruction of the scrotum and vulva: anatomical study. Ann Plast Surg 1984;13:504–510.
• 14. Cormack GC, Lamberty BGH. A classification of fascio-cutaneous flaps according to their patterns of vascularization. Br J Plast Surg.1984;37:80.
• 15. Cormack GC, Lamberty BGH. The blood supply of the thigh skin. Plast Reconstr Surg 1985;75:342–354.
• 16. Cormack GC, Lamberty BGH. The arterial anatomy of skin flaps. First ed. Edinburgh: Churchill Livingstone,1986.
• 17. Whetzel TP, Lechtmann AN. The gracilis myofasciocutaneous flap: vascular anatomy and clinical application. Plast Reconstr Surg. 1997;99:1642–1652.
• 18. Giordano PA, Abbes M, Pequignot JP. Gracilis blood supply: anatomical and clinical reevaluation. Br J Plast Surg 1990;43:266–272.
• 19. Persichetti P, Simone P, Berloco M, Casadei RM, Marangi GF, Cagli B, Di Lella F. Vulvo-perineal reconstruction: medial thigh septo-fascio-cutaneous island flap. Ann Plast Surg. 2003;50:85-9.
• 20. Kappler UA, Constantinescu MA, Büchler U, Vögelin E. Anatomy of the proximal cutaneous perforator vessels of the gracilis muscle. Br J Plast Surg. 2005;58(4):445-8.
• 21. G.G. Hallock, The conjoint medial circumflex femoral perforator and gracilis muscle free flap. Plast Reconstr Surg. 2004;113:339–346.
• 22. G.G Hallock, The medial circumflex femoral gracilis local perforator flap—a local medial groin perforator flap, Ann Plast Surg. 2003;51:460–464.
• 23. Maguina P, Palmieri TL, and Greenhalgh DG. Split thickness skin grafting for recreation of the scrotum following Fournier’s gangrene. Burns. 2003;29:857–862.
• 24. Moustafa MF: Gangrene of the scrotum: an analysis of ten cases. Br J Plast Surg. 1967;20:90–96.
• 25. Young WA, Wright JK. Scrotal reconstruction with a rectus abdominis muscle flap. Br J Plast. Surg. 1988;41:190.
• 26. Ramos RR, Andrews JM, Ferreira LM. A gracilis myocutaneous flap for reconstruction of the scrotum. Br J Plast. Surg. 1984;37:171.
• 27. Di Geronimo EM. Scrotal reconstruction utilizing a unilateral adductor minimus myocutaneous flap. Plast Reconstr Surg. 1982;70:749.
• 28. Wang N, Whetzel T, Mathes SJ, et al. A fasciocutaneous flap for vaginaland perineal reconstruction. Plast Reconstr Surg. 1987;80:95–103.
• 29. Hallock GG. Scrotal reconstruction following Fournier’s gangrene using the medial thigh fasciocutaneous flap. Ann Plast Surg. 1990;24:86.
• 30. McDougal WS. Scrotal reconstruction using thigh pedicle flaps. J Urol.1983;129:757.
• 31. Orticochea M. The musculo-cutaneous flap method: An immediate and heroic substitute for the method of delay. Br J Plast Surg. 1972;25:106.
• 32. Hurwitz DJ. Closure of a large defect of the pelvic cavity by an extended compound myocutaneous flap based on the inferior gluteal artery. Br J Plast Surg.1980;33:256.
• 33. Hurteau JE, Bostwick J, Nahai F, Hester R, Jurkiewicz MJ. V-Y advancement of hamstring musculocutaneous flap for coverage of ischial pressure sores. Plast Reconstr Surg. 1981;68:539.
• 34. Yousif NJ, Matloub HS, Kolachalam R, Grunert BK,Sanger JR. The transverse gracilis musculocutaneous flap. Ann Plast Surg. 1992;29:482.
• 35. Angrigiani C, Grilli D, Thorne CH. The adductor flap: a new method for transferring posterior and medial thigh skin. Plast Reconstr Surg. 2001;107(7):1725-31.
• 36. Hallock CG. The conjoint medial circumflex femoral perforator and gracilis muscle free flap. Plast Reconstr Surg. 2004;113(1):339-46.