KMID : 1038220220490030453
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Archives of Plastic Surgery 2022 Volume.49 No. 3 p.453 ~ p.456
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The ¡°Sombrero-Shape¡± Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene
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Sapino Gianluca
Gonvers Stephanie Cherubino Mario di Summa Pietro G.
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Abstract
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When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name ¡°sombrero¡± as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months' follow-up. The ALT flap design ¡°sombrero¡± modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure.
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KEYWORD
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surgical flaps, Fournier gangrene, reconstructive surgical procedures
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