Assessment of Outcomes After Limberg Flap Reconstruction for Scrotal Defects in Patients With Fournier's Gangrene

Mehmet Dadaci, MD; Mehmet Emin Cem Yildirim, MD; Serhat Yarar, MD; Bilsev Ince, MD


Wounds. 2021;33(3):65-69. 

In This Article

Materials and Methods

This retrospective, single-center study included 29 male patients with scrotal defects after multiple debridements who were treated from January 2013 to January 2018. The Meram Faculty of Medicine, Necmettin Erbakan University Clinical Research Ethics Committee in Konya, Turkey, approved the study. The patients were referred for perineal reconstruction from the general surgery and urology departments. Patients with defects involving less than 50% of the scrotal surface as well as those with irregular follow-up visits and those lost to follow-up were excluded from the analysis. Twenty-one patients (72.4%) with hemiscrotal defect and 8 patients (27.6%) with defects involving greater than 50% of the scrotal surface were included in this study. During the hospitalization of patients, this multidisciplinary process was managed by the departments of infectious diseases, general surgery, and urology.

Surgical Technique

Patients in this analysis all had undergone elective defect repair surgery following consecutive debridements and regression of inflammation. All patients underwent Limberg flap reconstruction at the lithotomy position under spinal anesthesia. Defect area was measured after debridement, and flap markings were done to cover the entire defect. In each case, a pedicle flap was marked on the proximal one-third of the anteromedial thigh according to defect size (Figure 1). Following skin incisions, the suprafascial plane was used for harvesting the flap to preserve the superficial lymphatic nodes. The harvested flap was subsequently placed on the defect area and secured with a fixation suture on a key point. In patients with double-sided defects in the scrotal area, bilateral Limberg flaps were harvested from both thighs, placed in the midline, and sutured to each other. In 8 patients with unilateral total and contralateral partial defects, a unilateral Limberg flap was sutured to the opposing side so that scrotal tissue could be released. Fat tissue was trimmed in cases of excess. Tension-free flap transposition was obtained in all cases. Donor areas were closed following the Hemovac (Zimmer Biomet) drain placement.

Figure 1.

Illustration of the Limberg flap for scrotal defect reconstruction.

Infection Control

Before and after the reconstruction of the scrotum, the infectious disease physicians followed the patients' wound cultures and infection parameters (leukocyte count, c-reactive protein concentration, and other common acute phase reactant markers). The infection committee generally started patients on a triple antibiotic regimen that included an aminoglycoside, metronidazole, and cephalosporin. Then, the antibiotic regimen was adjusted as needed according to each patient's wound culture findings. When a patient's wound culture showed no growth and infection parameters reached normal levels, the antibiotics were stopped.

Postoperative Follow-up

Before discharge, the wounds were photographed to establish a baseline for recovery, and flap dimensions were measured. Patients were given advice about personal care and strategies for cleaning themselves. They were advised to wash daily but to keep the wound site dry and ventilate the inguinal and perineal regions. On follow-up visits, patients were evaluated in terms of flap viability and postoperative complications.