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Background <p>Reconstruction of small-to-medium perineal defects (maximal diameter &lt; 10&#xa0;cm, or area &lt; 100cm<sup>2</sup>) after Fournier’s gangrene is challenging due to aesthetic requirements and the characteristic of high sensitivity in this area. The anterior obturator artery perforator(aOAP) propeller flap offers a reliable alternative.</p> Methods <p>We retrospectively studied 11 male patients (mean age 55; range 36–74) treated from March 2021 to March 2025. A two-stage approach was used: radical debridement and Negative pressure wound therapy (NPWT), followed by aOAP propeller flap reconstruction after infection was controlled. Donor sites were closed primarily.</p> Results <p>Nine of 11 flaps survived without complications. Of the remaining two, one flap had distal cyanosis, the other a hematoma, both healed well after further intervention. All donor sites healed primarily. Over a mean follow-up of 7.4 months (range: 3–14 months), the reconstructed areas maintained satisfactory aesthetic appearance, soft texture, and minimal donor-site morbidity with only linear scarring.</p> Conclusion <p>This staged NPWT-assisted wound-bed preparation and subsequent aOAP propeller flap reconstruction is effective for perineal defects with moderate soft tissue loss.</p> <p>Level of Evidence: Level IV, therapeutic study.</p>

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Reconstruction of male central perineal small- to medium-sized defects after Fournier’s Gangrene: a stage approach using anterior obturator artery perforator propeller flap

  • 期刊论文

  • 发表日期：

    2026年8月1日

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  • Ying Ke,
  • Rufei Deng,
  • Zhenyu Jiang,
  • Youlai Zhang,
  • Lijin Zou,
  • Yuanlin Zeng,
  • Guohua Xin

摘要

Background

Reconstruction of small-to-medium perineal defects (maximal diameter < 10 cm, or area < 100cm2) after Fournier’s gangrene is challenging due to aesthetic requirements and the characteristic of high sensitivity in this area. The anterior obturator artery perforator(aOAP) propeller flap offers a reliable alternative.

Methods

We retrospectively studied 11 male patients (mean age 55; range 36–74) treated from March 2021 to March 2025. A two-stage approach was used: radical debridement and Negative pressure wound therapy (NPWT), followed by aOAP propeller flap reconstruction after infection was controlled. Donor sites were closed primarily.

Results

Nine of 11 flaps survived without complications. Of the remaining two, one flap had distal cyanosis, the other a hematoma, both healed well after further intervention. All donor sites healed primarily. Over a mean follow-up of 7.4 months (range: 3–14 months), the reconstructed areas maintained satisfactory aesthetic appearance, soft texture, and minimal donor-site morbidity with only linear scarring.

Conclusion

This staged NPWT-assisted wound-bed preparation and subsequent aOAP propeller flap reconstruction is effective for perineal defects with moderate soft tissue loss.

Level of Evidence: Level IV, therapeutic study.