Penoscrotal Defects in Fournier’s Gangrene and its Reconstructive Challenges: Our Experiences

Abstract

Introduction: Fournier’s gangrene is a necrotizing fasciitis caused by mixed aerobic and anaerobic bacteria resulting in loss of skin and subcutaneous tissues in penoscrotal and perineal areas. Reconstruction of the defects varies from secondary closure, skin graft, local mobilization of remnant scrotal skin, burying the exposed testis inside the thigh and coverage by flaps. Reconstructive option depends on size of defect, extent and depth of soft tissue loss, location of defect and availability of local tissue. In this article different modalities of reconstruction and their outcome is described.

Method: From December 2016 to March 2018, ten patients (all male) were admitted to our unit. All patients were referred case from General Surgery department .The Patients’ age ranged from 22 to 73 years (mean 47.5) and all the patients suffered from Fournier’s gangrene from different predisposing factor. The average size of the scrotal defect was 77 cm2.Reconsrucive ladder was followed according to the size of defect, anatomical location of wound, extent of soft tissue loss, and availability of local tissue to cover the defects.

Result: One out of Total ten patients was treated with approximation of wound margins and had achieved good result with no complication. Two cases of split thickness skin graft had satisfactory graft take. Two cases were treated with bilateral advancement of scrotal skin and one with anteromedial thigh pouches and remaining four were reconstructed with superomedial thigh flap. Overall results were satisfactory and surgical complication was minimal.

Conclusion: We follow the simplest and effective mode of treatment to achieve both functional and cosmetic results. If skin loss is small to medium sized, secondary closure had an excellent outcome. If the defect is less than 50%, scrotal advancement flap is suitable. Skin graft is effective if healthy granulating wound is present and tunica vaginalis not involved. Placing the testis in anteromedial thigh pouches is suitable and effective with extensive scrotal tissue loss and scrotal advancement is not achieved. Superomedial thigh pedicled flap has the best cosmetic and functional outcome if defect size is big and extensive.