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Henry G, Brochet L, Serbu M, Mojallal A, Boucher F. Scrotal reconstruction after Fournier's Gangrene using the superficial circumflex iliac artery perforator (SCIP) propeller flap: A case report. ANN CHIR PLAST ESTH 2024; 69:320-325. [PMID: 38866679 DOI: 10.1016/j.anplas.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/14/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Fournier's gangrene, a rare infectious condition affecting the external genitalia, often requires aggressive medical-surgical interventions, resulting in variable scrotal tissue loss. Despite numerous proposed reconstruction techniques, achieving a consensus on the most effective approach that balances aesthetics and function remains elusive. This case report presents a one-year follow-up on scrotal reconstruction using a pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) propeller flap. CASE REPORT A 56-year-old patient with significant scrotal tissue loss due to Fournier's gangrene underwent scrotal reconstruction using a pedicled SCIP propeller flap. Optimal placement was ensured through a subcutaneous tunnel, with a thin thigh skin graft applied to cover the penile skin defect. DISCUSSION The SCIP flap is distinguished by its thin and pliable characteristics, rapid harvesting and featuring a discreet donor site. It stands as a compelling alternative to skin grafts, providing advantages in sensory restoration, color congruence, and resilience against tension. Considering the thickness of the reconstruction helps both in recovering testicular function and improving the appearance by restoring the natural contour. CONCLUSION The utilization of the pedicled SCIP propeller flap for scrotal tissue loss resulting from Fournier's gangrene has demonstrated both aesthetic and functional success, underscoring its potential as an effective reconstructive option.
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Affiliation(s)
- G Henry
- Plastic, Reconstructive, and Aesthetic Surgery Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, 8, Avenue Rockefeller, 69003 Lyon, France.
| | - L Brochet
- Department of Maxillofacial Surgery, Stomatology, Oral Surgery, and Facial Plastic Surgery, Lyon Sud Hospital, 165, Chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, 8, Avenue Rockefeller, 69003 Lyon, France
| | - M Serbu
- Plastic, Reconstructive, and Aesthetic Surgery Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - A Mojallal
- Plastic, Reconstructive, and Aesthetic Surgery Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, 8, Avenue Rockefeller, 69003 Lyon, France
| | - F Boucher
- Plastic, Reconstructive, and Aesthetic Surgery Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, 8, Avenue Rockefeller, 69003 Lyon, France
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Sisternas Hernández L, López Fernández S, Zamora Alarcón PD, Vega García C, Torrano Romero L, Fernández Garrido M. Posttraumatic Scrotal Reconstruction with a Pedicled "Extended" Superficial Circumflex Iliac Artery Perforator Flap: A Case Report. Arch Plast Surg 2024; 51:327-331. [PMID: 38737845 PMCID: PMC11081727 DOI: 10.1055/a-2166-8783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 09/01/2023] [Indexed: 05/14/2024] Open
Abstract
The superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been used for scrotal reconstruction after Fournier's gangrene, skin cancer, or infections. However, there are few publications with regard to penoscrotal reconstruction after a traumatic injury with this flap. In this article, we propose a new SCIP flap variation, the "extended" or "direct" SCIP flap, to effectively reconstruct a wide scrotal defect after a traumatic injury. The "extended" SCIP flap is designed medial and cranial to the anterosuperior iliac spine (ASIS) using the superficial branch of the SCIA as the main pedicle.
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Affiliation(s)
- Lucía Sisternas Hernández
- Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Susana López Fernández
- Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paúl D. Zamora Alarcón
- Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carmen Vega García
- Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Torrano Romero
- Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Manuel Fernández Garrido
- Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Suda S, Hayashida K. Crafting Contours: A Comprehensive Guide to Scrotal Reconstruction. Life (Basel) 2024; 14:223. [PMID: 38398732 PMCID: PMC10890180 DOI: 10.3390/life14020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
This review delves into reconstructive methods for scrotal defects arising from conditions like Fournier's gangrene, cancer, trauma, or hidradenitis suppurativa. The unique anatomy of the scrotum, vital for thermoregulation and spermatogenic function, necessitates reconstruction with thin and pliable tissue. When the scrotal defect area is less than half the scrotal surface area, scrotal advancement flap can be performed. However, for larger defects, some type of transplantation surgery is required. Various options are explored, including testicular transposition, tissue expanders, split-thickness skin grafts, local flaps, and free flaps, each with merits and demerits based on factors like tissue availability, defect size, and patient specifics. Also, physicians should consider how testicular transposition, despite its simplicity, often yields unsatisfactory outcomes and impairs spermatogenesis. This review underscores the individuality of aesthetic standards for scrotal reconstruction, urging surgeons to tailor techniques to patient needs, health, and defect size. Detailed preoperative counseling is crucial to inform patients about outcomes and limitations. Ongoing research focuses on advancing techniques, not only anatomically but also in enhancing post-reconstruction quality of life, emphasizing the commitment to continuous improvement in scrotal reconstruction.
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Affiliation(s)
| | - Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan;
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Rochlin DH, Lin W, Reitz RJ, Chen M, Buntic R, Watt A, Safa B. Phalloplasty Flap Salvage Using a Superficial Circumflex Iliac Artery Perforator Propeller Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5522. [PMID: 38288417 PMCID: PMC10817080 DOI: 10.1097/gox.0000000000005522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/08/2023] [Indexed: 01/31/2024]
Abstract
Background Partial phalloplasty flap loss presents an evolving challenge, largely due to the complex demands required for both aesthetics and function. We describe our novel experience using the superficial circumflex iliac perforator (SCIP) propeller flap for neophallus salvage when skin grafting alone provides insufficient soft tissue bulk or coverage. Methods We retrospectively reviewed patients who underwent SCIP propeller flap reconstruction after phalloplasty partial flap loss. After suprafascial dissection, superficial circumflex iliac vessel perforator(s) were isolated toward the femoral origin. The flap was rotated 180 degrees and inset into the ventral or distal neophallus depending on the region of flap loss. If glans reconstruction was required, the flap was tubularized before inset. Division and inset were performed at a second stage, followed by subsequent glansplasty, urethral creation, and/or penile implant placement. Results SCIP propeller flap reconstruction was performed for four patients after one to six debridements at a mean of 6.5 (range 1.0-19.2) months following the initial phalloplasty. Three patients had lost the ventral phallus due to venous insufficiency, arterial insufficiency, and excessive postoperative swelling, respectively. The fourth patient experienced near-total loss of the glans following penile implant insertion. Division and inset was performed at an average of 7.5 (range 5.0-12.0) weeks after SCIP flap. There were no complications related to SCIP flap viability. Conclusion The SCIP propeller flap allows salvage of partial flap loss following phalloplasty by providing thin, pliable soft tissue bulk and skin coverage with minimal donor site morbidity, without the need for microsurgery, allowing progression with subsequent reconstructive stages.
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Affiliation(s)
- Danielle H. Rochlin
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, Calif
| | | | - Robert J. Reitz
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, Calif
| | - Mang Chen
- G.U. Recon Clinic, San Francisco, Calif
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Kim W, Kim S, Sung H, Lee K, Pyon J. Penoscrotal defect reconstruction using loco‐regional flaps in treatment of extramammary Paget's disease: Experience and suggestion of a simplified algorithm. Microsurgery 2022; 43:316-324. [PMID: 36420576 DOI: 10.1002/micr.30988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reconstruction of penoscrotal defects resulted from margin-controlled excision of extramammary Paget's disease (EMPD) remains challenging, due to its unpredictably varying extents. The present study aimed to investigate outcomes of reconstruction of penoscrotal defects following radical excision of EMPD and to introduce a simplified algorithm for selecting reconstruction strategies. METHODS Patients with penoscrotal EMPD who were treated with wide excision and subsequent reconstruction from 2009 to 2020 were reviewed. Their demographics, operation-related characteristics, and postoperative outcomes were evaluated. RESULTS In total, 46 patients with a mean age of 64.9 years (range, 44-85 years) were analyzed. An average size of defects was 129.6 cm2 (range, 8-900 cm2 ). The most frequently involving anatomical subunit was scrotum, followed by suprapubic area and penile shaft. Twenty-six patients had defects spanning multiple subunits. The most commonly used reconstruction methods for each anatomical subunit were internal pudendal artery perforator (IPAP) flaps and/or scrotal flaps for scrotal defects, superficial external pudendal artery perforator (SEPAP) flaps for suprapubic defects, and skin grafts for penile defects. In all but four cases, successful reconstruction was achieved with combination of those reconstruction options. No major complications developed except for one case of marginal flap necrosis. All patients were satisfied with their aesthetic and functional results. CONCLUSIONS Diverse penoscrotal defects following excision of EMPD could be solidly reconstructed with combination of several loco-regional options. A simplified algorithm using in combination of IPAP flap, SEPAP flap, scrotal flap, and skin graft may enable efficient and reliable reconstruction of penoscrotal EMPD defects.
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Affiliation(s)
- Woo‐Ju Kim
- Department of Plastic Surgery, Chung‐Ang University Gwangmyeong hospital Chung‐Ang University School of Medicine Seoul Republic of Korea
| | - Su‐Hwan Kim
- Department of Plastic Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Hyun‐Hwan Sung
- Department of Urology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Kyeong‐Tae Lee
- Department of Plastic Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jai‐Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
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Han Z, Zhang K, Liu H, Liu Y, Zhang C. Clinical application of free inguinal flaps with retrograde blood supply anastomotic to repair soft tissue defects of extremities. Medicine (Baltimore) 2022; 101:e31661. [PMID: 36397334 PMCID: PMC9666192 DOI: 10.1097/md.0000000000031661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To observe the clinical efficacy of free inguinal flaps with retrograde blood supply anastomosis to repair skin and soft tissue defects in the limbs. A total of 25 patients with soft tissue defects of the limbs treated from January 2019 to December 2021 were selected and repaired with free inguinal flaps anastomotic with retrograde blood supply. All 25 skin flaps survived; 1 patient had skin flap infection and the wound healed gradually after symptomatic treatment, and 1 patient had venous embolism and the skin flap survived after re-anastomosis. The patients were followed up for 6 to 18 months after the operation. After healing, the patient recovered satisfactorily, and the flap had a good appearance, texture, and flexibility; a reoperation was not required. The patient was satisfied with the effect of the treatment. Retrograde vascular anastomosis with the anterolateral femoral perforator flap is safe and reliable for repairing the soft tissue defects of the limbs. It is convenient for micromanipulation and can achieve satisfactory clinical results, and thus is an ideal repair method.
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Affiliation(s)
- Zhongbing Han
- Department of Microsurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Kuankuan Zhang
- Department of Microsurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Haizhou Liu
- Department of Microsurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Yangyang Liu
- Department of Microsurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Changchun Zhang
- Department of Microsurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
- * Correspondence: Changchun Zhang, Department of Microsurgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China (e-mail:)
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Scaglioni MF, Meroni M, Fritsche E. Pedicled superficial circumflex iliac artery perforator flap for male genital reconstruction: A case series. Microsurgery 2022; 42:775-782. [PMID: 35730684 DOI: 10.1002/micr.30933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/26/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Different issues may cause defects in the genital region, including urological, infective, oncological and genetic problems which often lead to significant defects. This is a very delicate region and a successful coverage requires a thin, pliable and reliable solution. In this setting the SCIP flap might be an outstanding procedure. Despite being a well-known solution in the groin region, its employment for genital reconstructions is still poorly described. For this reason, we gather our experience with this procedure showing the efficacy of the SCIP flap in this specific region. PATIENTS AND METHODS In the present case series we included 6 male patients who received a soft tissue defect reconstruction by means of pedicled SCIP flap over the last year. The average age was 53.6 years old (range 34-79 years). Among them, 5 patients received a surgical excision because of severe acne (2 cases), Fournier's gangrene (2 cases), or scrotal squamous cell carcinoma (1 case). In 1 case the cause of the missing volume was testicle agenesis and the reconstruction was performed for cosmetic purposes. Size of the defects ranged from 7 cm × 4 cm to 20 cm × 6 cm. Elliptical shaped flaps were designed either mono- or bilaterally according to the need. All the flaps were supplied by the superficial branch of the SCIA. The range of rotation varied between 150° and 180° in order to reach the affected area. RESULTS The flaps' dimension ranged from 8 cm × 4 cm to 20 cm × 6 cm. All the patients were successfully treated. In 1 case we encountered a small wound dehiscence, which was managed conservatively. The mean follow-up was 9.5 months (range 6-12 months). Good cosmetic result was achieved in all cases and no urinary or sexual dysfunctions were reported. CONCLUSIONS The pedicle SCIP flap represents a reliable solution for genital and inguinal defects reconstructions. Its versatility can be exploited throughout the region providing very good quality tissues that can be used for the most disparate situations.
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Affiliation(s)
- Mario F Scaglioni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matteo Meroni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Elmar Fritsche
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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A Possible Distal End for Perforasome of the Superficial Circumflex Iliac Artery Perforator Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3602. [PMID: 34881154 PMCID: PMC8647895 DOI: 10.1097/gox.0000000000003602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022]
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The vascular exploration of the proximal femoral artery perforator region, an ideal donor site to choose cutaneous flaps of thin, supple, and glabrous skin: A cadaveric study. J Plast Reconstr Aesthet Surg 2021; 74:1999-2004. [PMID: 33526359 DOI: 10.1016/j.bjps.2020.12.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/12/2020] [Accepted: 12/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The thigh region is a well-known area for harvesting cutaneous flaps for microsurgery replacement, given the characteristics of the skin: thin, flexible, and glabrous. We investigated the vascular pattern of 32 cadaveric anteroproximal thighs for the possibility of an extended harvesting area, which we call the proximal femoral artery perforator region. MATERIALS AND METHODS We injected colored, radio opaque latex in the external iliac artery and investigated the perforator branches from the superficial circumflex iliac, femoral common, superficial, and deep femoral (profunda femoris) arteries to the skin of the proximal femoral artery perforator region. This region was divided into 3 equal subregions (superior, medial, and lateral), and their perforators were counted and measured. RESULTS There was no significant difference in the number of arterial pedicles across the three subregions: 30 superior, 35 inferolateral, and 27 inferomedial. The perforators had a cutaneous path in 81% of the cases, while 6% were musculocutaneous and 5% septocutaneous, without a significant difference in their proportion in the three subregions. The mean length and diameter of the pedicles were 5.39 ± 2.1 cm and 1.07 ± 0.4 mm, respectively, without significant differences in the three subregions. CONCLUSIONS The proximal femoral artery perforator region is a suitable area to generate flaps of various sizes and shapes, as needed by the surgeon. All perforators were constant and possessed a sufficient diameter and length for a successful anastomosis during the surgical procedure. The donor site retains all technical advantages to successfully replace areas of glabrous skin.
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