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old or debilitated patients, while young patients benefit challenging because it not only affects the physical and
from flap coverage. esthetic appearance but also has a major psychological
and social impact to the patient. Every case needs a
Several locoregional cutaneous and fasciocutaneous customized approach. The choice depends upon the
flaps from thigh, perineal, and groin areas have been surgeon’s preferences, condition of the patient, and ability
described to reconstruct the penoscrotal region. Local to achieve the best reconstructive results with the least
flap advancement provides a faster and simpler option morbidity.
of coverage, but the aesthetic appearance may not be
pleasant to the younger patients. Financial support and sponsorship
Nil.
The ALT flap provides excellent closure for extensive defects
of the penoscrotal region because it is easy to rotate Conflicts of interest
over the defect and provides excellent aesthetic results. There are no conflicts of interest.
Further thinning may be required as they are inherently
bulky flaps though supra-thin flaps have also been described. REFERENCES

The fasciocutaneous flap of the inner thighs has excellent 1. Kolehmainen M, Suominen S, Tukiainen E. Pelvic, perineal and genital
vascularization because of the presence of the branches reconstructions. Scand J Surg 2013;102:25-31.
of the femoral artery (internal and circumflex pudendal 2. Lee SH, Rah DK, Lee WJ. Penoscrotal reconstruction with gracilis
arteries), making the flap very safe even in diabetic and muscle flap and internal pudendal artery perforator transposition. Urology
vasculopathic patients. [7,8] 3. 2012;79:1390-4.
Chen SY, Fu JP, Chen TM, Chen SG. Reconstruction of scrotal and perineal
defects in fournier’s gangrene. J Plast Reconstr Aesthet Surg 2011;64:528-34.
Many myocutaneous flaps have been described, including 4. Millard DR Jr. Scrotal construction and reconstruction. Plast Reconstr Surg
the rectus abdominis myocutaneous flap, the gracilis 1966;38:10-5.
myocutaneous flap, and composite gastric seromuscular 5. Maguiña P, Palmieri TL, Greenhalgh DG. Split thickness skin grafting
for recreation of the scrotum following Fournier’s gangrene. Burns
and omental pedicled flaps. [9-11] These procedures produce 2003;29:857-62.
acceptable cosmetic results, and the flaps take readily 6. Ellabban MG. Single stage muscle flap reconstruction of major scrotal
even in the contaminated environment. Limitations of defects. Burns 2004;30:505.
muscle flaps include loss of functioning muscle, poor 7. Yang J, Ko SH, Oh SJ, Jung SW. Reconstruction of a perineoscrotal
defect using bilateral medial thigh fasciocutaneous flaps. Arch Plast Surg
sensation, and scarring on thighs and lower abdomen. 2013;40:72-4.
8. Ferreira PC, Reis JC, Amarante JM, Silva AC, Pinho CJ, Oliveira IC, da Silva
Perforator-based flaps include the medial thigh flap, PN. Fournier’s gangrene: a review of 43 reconstructive cases. Plast Reconstr
paraumbilical perforator-based cutaneous island flap, Surg 2007;119:175-84.
medial circumflex femoral artery perforator flap, and 9. Karsidag S, Akcal A, Sirvan SS, Guney S, Ugurlu K. Perineoscrotal
reconstruction using a medial circumflex femoral artery perforator flap.
pedicled deep inferior epigastric perforator flap. [11,12] These Microsurgery 2011;31:116-21.
flaps are thin, which is aesthetically and functionally ideal for 10. Parkash S, Gajendran V. Surgical reconstruction of the sequelae of penile and
scrotum replacement. However, these flaps are technically scrotal gangrene: a plea for simplicity. Br J Plast Surg 1984;37:354-7.
difficult, and their blood supply is less predictable. 11. Gencosmanoğlu R, Bilkay U, Alper M, Gürler T, Cağdaş A. Late results of
split-grafted penoscrotal avulsion injuries. J Trauma 1995;39:1201-3.
12. Monteiro E, Carvalho P, Costa P, Ferraro A. “Inner thigh lift flap” for Fournier
In conclusion, reconstruction of the penoscrotal region is gangrene of the scrotum. Plast Reconstr Surg 2002;110:1372-3.

Plast Aesthet Res || Vol 3 || Issue 2 || Feb 29, 2016 67