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Sawayama H, Miyanari N, Sugihara H, et al. A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report. Surg Case Rep. 2017;3(1):74doi: 10.1186/s40792-017-0350-y.
Sawayama, H., Miyanari, N., Sugihara, H., Iwagami, S., Mizumoto, T., Kubota, T., Haga, Y., & Baba, H. (2017). A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report. Surgical case reports, 3(1), 74. https://doi.org/10.1186/s40792-017-0350-y
Sawayama, Hiroshi, et al. "A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report." Surgical case reports vol. 3,1 (2017): 74. doi: https://doi.org/10.1186/s40792-017-0350-y
Sawayama H, Miyanari N, Sugihara H, Iwagami S, Mizumoto T, Kubota T, Haga Y, Baba H. A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report. Surg Case Rep. 2017 Dec;3(1):74. doi: 10.1186/s40792-017-0350-y. Epub 2017 May 26. PMID: 28550641; PMCID: PMC5446431.
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Surg Case Rep. 2017 Dec;3(1):74. doi: 10.1186/s40792-017-0350-y. Epub 2017 May 26.

A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report.

Surgical case reports

Hiroshi Sawayama, Nobutomo Miyanari, Hidetaka Sugihara, Shiro Iwagami, Takao Mizumoto, Tatsuo Kubota, Yoshio Haga, Hideo Baba

Affiliations

  1. Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Kumamoto, 860-0008, Japan.
  2. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan. [email protected].

PMID: 28550641 PMCID: PMC5446431 DOI: 10.1186/s40792-017-0350-y

Abstract

BACKGROUND: Fournier gangrene due to advanced rectal cancer is a rapidly progressive gangrene of the perineum and buttocks. Emergency surgical debridement of necrotic tissue is crucial, and secondary surgery to resect tumors is necessary for wound healing. However, pelvic exenteration damages the pelvic floor, increasing the likelihood of herniation of internal organs into the infectious wound. The management of pelvic exenteration for rectal cancer with Fournier gangrene has not yet been established. We herein describe the use of a fascia lata free flap in pelvic exenteration for rectal cancer with Fournier gangrene.

CASE PRESENTATION: A 66-year-old male who had undergone colostomy for large bowel obstruction due to advanced rectal cancer and continued chemotherapy was referred to our hospital for Fournier gangrene resulting from chemotherapy. Emergency surgical debridement was performed, and the infectious wound around the rectal cancer was treated with intravenous antibiotic agents postoperatively. However, the tumor was exposed by the wound, and exudate persisted. Pelvic exenteration was performed due to tumor infiltration into the bladder and prostate. Tumor resection resulted in a defect in the pelvic floor. A fascia lata free flap (15 × 9 cm) obtained from the left thigh was fixed to the edge of the peritoneum and ileal conduit to close the defect in the pelvic floor and prevent small bowel herniation into the resected space. There was no intraabdominal inflammation or bowel obstruction postoperatively, and outpatient chemotherapy was continued.

CONCLUSIONS: Surgical repair with a fascia lata free flap to close the defect in the pelvic floor led to a good clinical outcome for pelvic exenteration in a patient with Fournier gangrene due to advanced rectal cancer.

Keywords: Fascia lata; Fournier gangrene; Pelvic exenteration; Rectal cancer

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