Reconstruction of penile skin loss by superficial circumflex iliac perforator (SCIP) pedicled flap after Fournier's gangrene

INTRODUCTION

Fournier's gangrene is a serious pathology with a high mortality rate. Treatment requires a large debridement of necrotized tissues, conducing to a skin loss, requiring a reconstruction, which may involve different surgical techniques, depending on the context as well as the size and location of the skin loss. The most common covering technique uses split-thickness skin grafting, which however presents a risk of contracture.

CASE

Our 63 years old patient presented a Fournier's gangrene, leading to pubic and circular penile skin defects after multiple debridements. We decided to practice a right superficial circumflex iliac perforator (SCIP) pedicled flap to reconstruct the penile skin sheath. The flap was rotated 180 degrees and rolled around the penis.

DISCUSSION

The inguinal pedicle flap is described for penile reconstruction, the SCIP flap for perineal reconstruction, and even bilateral SCIP flaps for performing phalloplasty, but SCIP pedicled flap is not already described for isolated penile skin sheath reconstruction. Skin loss in our patient was not extensive, permitting us to perform this surgical technique. To go further, note the possibility of carrying out this reconstruction by a super-thin SCIP flap, as a pure skin graft flap.

CONCLUSION

The SCIP pedicled flap seems us to be a safe technique for penile skin reconstruction and a good alternative to the usual skin grafts, especially regarding the lower risk of contracture, and low donor-site morbidity.

[Satisfaction and quality of life after DIEP-flap breast reconstruction]

Satisfaction and quality of life of patients who have undergone DIEP-flap breast reconstruction have been assessed by many authors in many countries using standardized tools. However, some simple and practical information is often not found in these studies. The aim of our work was to carry out a practical satisfaction survey of patients reconstructed by DIEP flap in our center. Our cohort was made up of 207 patients who underwent DIEP-flap breast reconstruction in Marseille between January 2014 and December 2020. A letter containing our original satisfaction survey was sent to all the patients in our sample. We received 104 responses, which were statistically analyzed using the flat sorting method. Nine-two percent of patients were globally satisfied with the result of their breast reconstruction. A large majority of patients are in favor of the idea of performing their reconstruction again using a DIEP flap. Fifty-five percent of participants were "not bothered at all" by their abdomen after their surgery. The DIEP flap is a versatile technique that allows surgeons to offer it in multiple breast reconstruction situations and to obtain a high degree of patient satisfaction.

The two-stage free flap strategy: An alternative to reconstruct major oncological surgical defects with noble organ exposure

BACKGROUND

To minimize the risk of viscera exposure for parietal or calverial reconstruction after tumor removal, we used the two-stage free flap strategy. The flap was transferred a few days before tumor resection and left in a standby position until the second stage.

PATIENTS AND METHOD

We conducted a retrospective monocentric study. All patients who underwent reconstruction with the two-stage free flap strategy after tumor resection since 2000 were included.

RESULTS

We performed 14 two-stage flaps (8 for calvaria, 3 for abdomen, and 3 for thorax) on 12 patients. The average skin paddle surface was 318 cm². The mean operative time was 274min for the first stage and 172min for the second stage. The average time between the two stages was 8.8 days (2 to 24 days). One flap necrosis, one venous thrombosis, and one hematoma were observed after the first stage. Partial skin paddle necrosis (2 flaps) and infections (3 flaps) occurred after the second stage. The mean follow-up was 20 months (6 to 61 months), and two patients had tumor recurrence.

CONCLUSIONS

The two-stage free flap strategy is another option for major oncological reconstructions, to be safe and reliable some rules must be followed. The flap must contain a large skin paddle to ensure flap autonomization and to allow for complete tight plication of the flap between the two stages, which limits germ colonization. A short delay between the two stages (<12 days) decreases the risk of infection. The presence of a plastic surgeon during the second stage decreases the risk of pedicle trauma.