[Uni- and bilateral pedicled muscular gracilis flaps for reconstruction of the scrotum in Fournier's gangrene]. / Skrotum-Rekonstruktion nach Fournier-Gangrän mit uni- und bilateral gestielter rein muskulärer M.gracilis-Lappenplastik.

Fournier's gangrene is still a major cause for the development of soft tissue defects of the perineum and is associated with a mortality of 40-67% of all patients. Along with the initial life-preserving treatment such as broad-spectrum antibiotics and multifold agressive surgical debridement, reconstruction of the body contour is of the utmost importance for these patients. An individual adjustment of treatment in every single case is required due to the wide variety of the resulting complex soft tissue defects and differing patient profiles. Most publications describe the use of musculo- or fasciocutaneous flaps for scrotal reconstruction. In this paper, we present two cases of successfully performed plastic reconstructions of the scrotum using a solely muscular gracilis flap to cover the exposed testicles, followed by a split-skin graft to cover the muscle. The plasticity of the muscle and the variability of flap design resulted along with the transplanted mesh-graft in an excellent outcome for the patient with respect to function, form and quality of life.

Measures to prevent complications of distally based neurovascular sural flaps.

Several publications in recent years have proven unbroken popularity of superficial sural artery flaps for the coverage of defects of the lower leg and proximal foot. However, complications are being discussed rarely. The realistic complication rate is up to 59%, given corresponding comorbidities, risk factors, or performance errors. Twelve distally based neurovascular sural flaps were used for reconstruction of heel, ankle, and lower-leg defects between 2003 and 2005. The following pre- and postoperative procedures were performed as a routine: An additional arteriography was done preoperatively to prove the patency of the peroneal artery. Acoustic Doppler ultrasound was used to identify the lesser saphenous vein and the concomitant vessels (perforators of the peroneal artery) of the sural nerve. An enlarged skin paddle with a tail of skin over the pedicle at the point of rotation was harvested intraoperatively to take pressure off the vessels and facilitate primary closure. Postoperatively, external fixation provides strict immobilization of the affected leg. Following these measures, no flap loss was observed in the presented series, and only few minor complications occurred.