We present the case of a 40-year-old man treated for Fournier gangrene. After the resection of necrotic tissues, a large perineal defect remained, extending to the left inguinal area (Figure 1A). A two-stage repair was performed, using lateral advancement flaps, with the detachment of skin and fat. In the first stage, lateral flaps of skin and subcutaneous tissue were detached from the posterior perineum for advancement and closure, and brought towards the anterior perineal area (Figure 1B), in preparation for the second stage, in which complete closure was achieved, applying the same technique (lateral skin-and-fat flaps) (Figure 1C).

All breast reduction and mastopexy procedures employ a periareolar closure. No matter the surgical technique, whether it is a periareolar mastopexy, short scar technique or wise pattern reduction, the periareolar closure is ever present and forms a vital component of the procedure. The periareolar closure component is often described as the most complex part of the operative closure [1,2]. There is evidence that periareolar closures completed with an absorbable suture may be prone to significant widening, hypertrophy and/or areolar distortion, and in an effort to avoid this some surgeons use a non-absorbable/permanent suture material. This in turn opens the door to other potential risks including suture infection and extrusion. A review of current techniques used in periareolar closure and recent advances has been undertaken. At this time there is no significantly superior technique and this area warrants further study.