Scrotal Reconstruction by the Gracilis Muscle Flap Following Fournier's Gangrene

Fournier's gangrene is life-threatening disease characterized by abrupt onset of a rapidly progressive necrotizing soft tissue infection involving the perineum and scrotum. In Fournier's original descriptions, the disease arose in healthy subjects without an obvious cause. Despite controversy still surrounds its etiology, current studies identify definite urologic and colorectal causes with its combined disease in a majority of cases. We experienced cases of large scrotal and perineal defect caused by Fournier's gangrene. Aggressive and extensive debridement with a parenteral broad spectrum antimicrobial agents was executed at the important points to the treatment. The patient also received adjuvant hyperbaric oxygen therapy. The clinical efficacy of hyperbaric oxygen was discussed. After control of infection and unavoidable loss of soft tissue, the major concern following Fournier's gangrene lies on the protection of the testicles and adequate volumetric scrotal appearance. The defect was successfully reconstructed with unilateral or bilateral gracilis muscle flap transposition and split- thickness skin graft. We present this article utilizing bilateral gracilis muscle flaps as an acceptable alternative in the approach to scrotal reconstruction in Fournier's gangrene.

Repair of Complicated Posterior Urethral Stricture Using Inferior Pubectomy and Gracilis Muscle Flap / 대한비뇨기과학회지

PURPOSE: To evaluate the usefulness of an inferior pubectomy and a gracilis muscle flap for the reconstruction of a complicated posterior urethral stricture, where urethroplasty had failed, or due to a long urethral defect. MATERIALS AND METHODS: A total of sixty eight patients with complicated posterior urethral strictures, following a pelvic bone fracture, were managed by a one-stage perineal repair at Pundang CHA hospital between March 1998 and April 2002. End-to-end anastomosis was performed in all cases, with corporeal body separation, or an inferior pubectomy and transposition of the gracilis muscle flap performed in a progressive manner if required. RESULTS: The success rate of all the cases was 95.6%. Additional procedures made no differences to the incidence of impotence, and the incidences of restricture and incontinence were low. CONCLUSIONS: Our results shows that an inferior pubectomy and a gracilis muscle flap can be useful methods in the treatment and prevention of incontinence and restricture in most cases of complicated posterior urethral strictures.

2 Cases of Female Lower Urinary Tract Fistula Treated with Gracilis Muscle Flap / 대한비뇨기과학회지

The successful closure of a fistula clearly involves application of spectrum of techniques depending variable factors. There was variety of opinions regarding the timing and optimum surgical technique for repair of fistula. Several muscles and myocutaneous flaps are applicable to a variety of tissue defects. The gracilis muscle is especially useful as adjuncts for wound coverage, vaginal or penile reconstruction and as interpositional tissue for the closure of various fistulas. We experienced two cases of female urinary tract fistula treated with gracilis muscle flap successfully.