Reconstruction of Large Penoscrotal Defects Following Fournier's Gangrene Using Pedicled Vertical DIEP Flap: Case Series and Evaluation of Long-Term Results.

Abstract

Fournier's Gangrene is a necrotizing fasciitis of the penoscrotal region that presents significant challenges for reconstruction. Although various reconstruction options exist for small- to medium-sized defects following Fournier's Gangrene, options for large and complex defects remain limited. The aim of this study is to evaluate the feasibility of the pedicled vertical DIEP flap for the reconstruction of large penoscrotal defects resulting from Fournier's Gangrene and to assess long-term outcomes of this flap-based approach. Between December 2022 and January 2024, we performed pedicled vertical DIEP flap reconstruction in 17 patients with large penoscrotal defects due to Fournier's Gangrene. All patients were male, with a mean age of 57.7 years. The penoscrotal defect sizes ranged from 12 × 8 to 30 × 20 cm. Long-term outcomes were assessed using the Patient and Observer Scar Assessment Scale (POSAS) and the Changes in Sexual Function Questionnaire-14 (CSFQ-14). POSAS was applied by 2 independent observers to evaluate satisfaction with aesthetic outcomes, whereas CSFQ-14 was used to assess changes in sexual function. The flap sizes ranged between 16 × 8 and 25 × 13 cm, with an average of 2.7 perforators. All flaps survived, although partial necrosis occurred in 3 cases. The mean hospitalization period was 20 days. All donor sites, except in 1 patient, were primarily closed. The mean POSAS scores were 2.53 ± 0.72 for patients, 2.29 ± 0.69 for observer 1, and 2.71 ± 0.85 for observer 2. Patients reported satisfaction with the aesthetic results. The mean CSFQ-14 score was 41.47 ± 19.96. The pedicled vertical DIEP flap should be considered a viable alternative for reconstructing large penoscrotal defects following Fournier's Gangrene. Its ability to provide single-stage closure of extensive defects may reduce hospitalization time and morbidity.