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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(03): 453-456
DOI: 10.1055/s-0042-1748663
Extremity/Lymphedema
Case Report

The “Sombrero-Shape” Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene

Gianluca Sapino
1   Department of Plastic and Hand Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, CH, Switzerland
,
Stephanie Gonvers
1   Department of Plastic and Hand Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, CH, Switzerland
,
Mario Cherubino
2   Department of Plastic, Reconstructive and Hand Surgery, Varese University Hospital, Varese, Italy
,
Pietro G. di Summa
1   Department of Plastic and Hand Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, CH, Switzerland
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Abstract

When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name “sombrero” as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months' follow-up. The ALT flap design “sombrero” modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure.

Keywords

surgical flaps - Fournier gangrene - reconstructive surgical procedures

Author Contributions

Conceptualization: P.G.d.-S., G.S., and M.C. Data curation: S.G. and G.S. Formal analysis: P.G.d.-S., G.S., and M.C. Methodology: S.G., G.S, and P.G.d.-S. Writing-original draft: S.G., G.S, and P.G.d.-S.


Patient Consent

Patient's informed written consent was obtained for use of photos. Patient data were treated according to the Declaration of Helsinki as modified in 2013.




Publication History

Article published online:
27 May 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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