Reconstruction of penile skin loss by superficial circumflex iliac perforator (SCIP) pedicled flap after Fournier's gangrene.

INTRODUCTION: Fournier's gangrene is a serious pathology with a high mortality rate. Treatment requires a large debridement of necrotized tissues, conducing to a skin loss, requiring a reconstruction, which may involve different surgical techniques, depending on the context as well as the size and location of the skin loss. The most common covering technique uses split-thickness skin grafting, which however presents a risk of contracture. CASE: Our 63 years old patient presented a Fournier's gangrene, leading to pubic and circular penile skin defects after multiple debridements. We decided to practice a right superficial circumflex iliac perforator (SCIP) pedicled flap to reconstruct the penile skin sheath. The flap was rotated 180 degrees and rolled around the penis. DISCUSSION: The inguinal pedicle flap is described for penile reconstruction, the SCIP flap for perineal reconstruction, and even bilateral SCIP flaps for performing phalloplasty, but SCIP pedicled flap is not already described for isolated penile skin sheath reconstruction. Skin loss in our patient was not extensive, permitting us to perform this surgical technique. To go further, note the possibility of carrying out this reconstruction by a super-thin SCIP flap, as a pure skin graft flap. CONCLUSION: The SCIP pedicled flap seems us to be a safe technique for penile skin reconstruction and a good alternative to the usual skin grafts, especially regarding the lower risk of contracture, and low donor-site morbidity.

Spare part's free contralateral medial plantar flap for emergency reconstruction in a bilateral lower legs ballistic trauma.

The medial plantar flap is frequently used in heel reconstruction and has been described since 1969. We took care of a 25-year-old patient with a bilateral ballistic trauma and open fractures to the distal third of both legs. Given the seriousness of the damage to the left lower limb, a trans-tibial amputation had to be performed. Concerning the right lower limb, we decided to cover the defect with a spare part's free medial plantar flap thanks to the amputated fragment. The extremity spare tissues principle is already known and described, more particularly concerning hands, in emergency traumatic surgery and in planned surgery, mainly concerning thumb reconstruction, for example for hypoplasia or after traumatic amputation. Apart from an article on the use of foot spare part in the coverage of amputation stumps, no article has reported the use of a foot spare part in reconstructive surgery, even more in traumatic surgery. We believe that the use of an extremity spare tissues should be considered in rare cases where this is possible, in order to reduce donor-site morbidity in the context of reconstructive surgery.

Serum placental protein 14 (PP14) levels in patients with threatened abortion.

Serum placenta protein 14 (PP14) were significantly lower serum levels in patients with threatened abortion at 10 to 20 weeks controls than in normal (normal group, n = 133, median: 52,0 microgram/l [16-83, SD: 17,9],risk group: n=20, median: 34,0 microgram/l [13-63, SD: 13,7]).

Occupational exposure to hexachlorocyclohexane. IV. Sex hormone alterations in HCH-exposed workers.

In a lindane (gamma-hexachlorocyclohexane)-producing factory 54 male workers (mean age 40 years, mean duration of exposure 8 years) were studied with regard to their blood levels of testosterone, LH, and FSH. Twenty clerks of nearly the same age were examined for control purposes in the same way. Serum-LH concentrations of the exposed workers were significantly higher than in controls. Geometric mean values were 8.8 mIU/ml and 5.7 mIU/ml respectively. On the other hand, FSH levels were insignificantly higher. Concerning testosterone concentrations in serum, these were found to be slightly lower in the group of workers than in control persons but this difference could not be proved to be statistically significant. These results indicate certain perturbations in sex hormone regulation probably as a consequence of HCH-exposure. To judge the pathological significance of these alterations further investigation will be necessary.