SCROTAL RECONSTRUCTION WITH A PEDICLED GRACILIS MUSCLE FLAP AFTER DEBRIDEMENT OF FOURNIER'S GANGRENE: A CASE REPORT

As part of surgical management of Fournier's gangrene, multiple and extensive debridement of necrotic tissue is done which results in significant loss of scrotal skin and exposure of testes. This necessitates reconstruction of a neoscrotum to cover of the testes. Several scrotal reconstructive options are available including split thickness skin grafts, scrotal advancement flaps, local fasciocutaneous, muscle or myocutaneous flaps, and free tissue transfer. We report a case of a 34 year old African male who presented as a referral from a district hospital with a scrotal defect and exposed testes following extensive debridement of Fournier's gangrene. Scrotal reconstruction with a pedicled gracilis muscle flap was done. The pedicled gracilis muscle flap is close to the scrotal area and is ideal for coverage of large scrotal defects with deep pockets. It is well vascularised thereby providing greater resistance to infection, a good bed for skin grafting yet eliminating the risks associated with potentially non reliable skin paddle in the myocutaneous flap.

Short-term surgical missions: joining hands with local providers to ensure sustainability

Short-term surgical missions may appear to fill a void in surgical capacity in the developing world, but may inadvertently also disrupt well-established local healthcare systems. The surgical providers of an East African hospital developed suggestions for improving these missions so that they can benefit visitors, local providers and patients alike.