Pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) flap for perineo‐scrotal reconstruction following Fournier's gangrene

• Published in: ANZ journal of surgery 2023-01, Vol.93 (1-2), p.276-280
• Main Authors: B, Sandeep, Khanna, Anmol, Taylor, Duncan
• Format: Article
• Language: English
• Subjects: Complications; Contamination; Debridement; Defects; Fasciitis; Feces; flap; Fournier gangrene; Fournier Gangrene - surgery; Fournier's gangrene; Gangrene; Humans; Iliac Artery - surgery; Male; Middle Aged; Necrotizing fasciitis; Perforator Flap - blood supply; perineo‐scrotal defect; Plastic Surgery Procedures; Postoperative; Psychology; Reconstruction; scip; Scrotum - surgery; Skin; Skin grafts; Surgical Flaps
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.18066

Background Fournier's gangrene is a form of necrotising fasciitis involving perineo‐scrotal skin. It is treated with radical debridement, infection control and often leaves a large anatomical defect that is challenging to reconstruct. The anatomical location of the defect leads to faecal contamination, difficulties when mobilizing, and negative psychological impact. Traditional approaches for managing such defects have relied on either healing by secondary intention or skin grafting. There are few reported cases in the literature to cover such defects with a flap. Methods Pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) flap reconstruction was performed in three patients who had perineo‐scrotal defects following debridement for Fournier's gangrene. Results All flaps survived with no significant postoperative complications and good functional and aesthetic outcomes were achieved. The mean age of patient was 52 years and the largest defect measured 22 × 10 cm. Conclusion The reconstruction of perineo‐scrotal defects is difficult despite a range of reconstructive options. The pedicled SCIP flap offers many advantages over standard techniques. This flap is thin, pliable, and has a consistent anatomy. With continued experience, we feel that this flap could be considered the gold standard of treatment for such defects. Perineoscrotal defects are difficult to reconstruct. SCIP flap is an easy and a reliable option for reconstructing scrotal defects following Fournier's gangrene. The flap is naturally thin flap and provides good aesthetic and functional coverage. With continued experience SCIP could be considered the gold standard treatment of perineoscrotal defects.