Anterolateral Thigh Flap for Abdominal Wall Defect After Debridement for Meleney's With Fournier's Gangrene: A Case Report of a Rare Outcome

Abstract

Meleney's gangrene is a synergistic polymicrobial infection of the anterior abdominal wall causing rapidly progressive necrotizing fasciitis of skin and subcutaneous tissues. When combined with Fournier's gangrene, the mortality rates are higher. Here, we discuss a case of Meleney's with Fournier's gangrene managed with appropriate antibiotics and extensive wound debridement, followed by a successful split-thickness skin grafting of the lower anterior abdominal wall and scrotum. The patient presented after three months with a ventral hernia. The hernial sac was de-epithelialized and preperitoneal on-lay mesh repair was done. The defect necessitated a flap cover. Hence, a lateral circumflex artery-based pedicled anterolateral thigh (ALT) flap was raised and placed over the mesh to restore the fascial contour and structural integrity of the abdominal wall.

Keywords: anterolateral thigh flap; fournier’s gangrene; meleney’s gangrene; split-thickness skin grafting; wound debridement.