Hsu Honda, Lin Chih Ming, Sun Tzong-Bor, Cheng Li-Fu, Chien Sou-Hsin
Division of Plastic Surgery, Buddhist Tzi Chi General Hospital, Hualien, Taiwan.
J Plast Reconstr Aesthet Surg. 2007;60(9):1055-9. doi: 10.1016/j.bjps.2006.09.005. Epub 2007 Feb 22.
Extensive defects of the perineal area, with exposure of the testes, are difficult to reconstruct. Numerous reconstruction methods are available, but few provide us with an aesthetically acceptable, thin and pliable cover. The gracilis myocutaneous flap had the disadvantage of an unreliable skin paddle since McCraw's original description. Our method of using a longitudinally orientated gracilis myofasciocutaneous flap with wide incorporation of the perigracilis fascia, provided us a large reliable cutaneous territory and allowed us to repair extensive perineal defects in one single operation.
Eight patients treated for Fournier's gangrene between 2003 and 2005 were enrolled in the study. All patients underwent early, aggressive surgical debridement followed by surgical reconstruction with a gracilis myofasciocutaneous flap.
The size of the defect ranged from 12 cm x 7 cm to 30 cm x 15 cm. Diverting colostomy was performed in six of the eight patients. All patients recuperated well with good coverage of the defects. No wound dehiscence due to excessive tension was seen. Haematoma developed in one patient. One patient developed an abscess in the distal part of the donor thigh three months after the initial flap coverage.
Gracilis myofasciocutaneous advancement flap provides a good cover for the perineal defect with testicular exposure. It is technically easy and has favourable functional and aesthetic results. It allows the surgeon the ability to reconstruct the perineal and scrotal defects in one single stage.
会阴区广泛缺损并伴有睾丸外露，修复起来颇具难度。虽然有多种重建方法可供选择，但能提供美观、薄且柔韧覆盖物的方法却寥寥无几。自麦克劳最初描述以来，股薄肌肌皮瓣存在皮瓣不可靠的缺点。我们采用纵向定向的股薄肌肌筋膜皮瓣并广泛纳入股薄肌周围筋膜的方法，为我们提供了一个大的可靠皮肤区域，使我们能够在一次手术中修复广泛的会阴缺损。
纳入2003年至2005年间因福尼尔坏疽接受治疗的8例患者。所有患者均早期积极行手术清创，随后用股薄肌肌筋膜皮瓣进行手术重建。
缺损大小从12 cm×7 cm至30 cm×15 cm不等。8例患者中有6例行转流性结肠造口术。所有患者恢复良好，缺损得到良好覆盖。未见因张力过大导致的伤口裂开。1例患者出现血肿。1例患者在最初皮瓣覆盖3个月后，供区大腿远端出现脓肿。
股薄肌肌筋膜推进皮瓣可为伴有睾丸外露的会阴缺损提供良好覆盖。该方法技术操作简便，功能和美学效果良好。它使外科医生能够在一个阶段内重建会阴和阴囊缺损。
