Abdominal Implantation of Testicles in the Management of Intractable Testicular Pain in Fournier Gangrene

Abstract

Fournier gangrene (FG) is a necrotizing soft tissue infection involving the superficial and fascial planes of the perineum. In many cases of FG, debridement of the scrotum is necessary, leaving definitive management of the exposed testicles a significant surgical challenge. Frequent incidental trauma to the testicles can cause severe pain, especially in laborers. Practical surgical solutions are few and not well detailed. Various options exist, including creating a neoscrotum with adjacent thigh tissue, split-thickness skin grafts (STSGs), or even creating a subcutaneous thigh pocket. We describe a case of abdominal implantation of bilateral testicles for persistent testicular pain in a case where STSGs did not provide adequate protection, adjacent thigh skin was not available for creation of a neoscrotum, and significant cord contracture occurred. We detail the advantages and disadvantages of the commonly described techniques, including this approach, and how in select individuals this may be a suitable alternative.

Contemporary diagnosis and management of Fournier’s gangrene

“…Chan and collages state that implantation of the exposed testicle into an adjacent subcutaneous thigh flap can provide a shorter hospital stay and reduce recovery time. However, this technique is only temporizing, allowing the patient more time to recover until definitive scrotal reconstruction can be undertaken [Chan et al . 2013].…”

A Rare Case of Idiophatic Fournier’s Gangrene: Scrotal Reconstruction via Anterolateral Thigh Flap

“…This method is temporary, however, it enhances recovery and provides a shorter hospitalization time, until conclusive scrotal reconstruction can be undertaken. 13,14 There is a chance that this technique would have reduced the number of surgical procedures performed for our patient.…”

Reconstruction of perineo-scrotal defects from Fournier’s gangrene with the adipofascial anterolateral thigh flap

“…Historically defined as a sudden-onset, rapidly progressive gangrenous infection of the perineum and scrotum in a male subject without an identifiable cause, the common cause in current clinical practice is a necrotising mixed-organism infection following sepsis, or invasive interventions in the perineal area or lower abdomen. Today, the definition more loosely encompasses any necrotising soft tissue infection of the perineum in either males or females, regardless of aetiology (4).…”