Algorithm of rational approach to reconstruction in Fournier’s disease

Abstract

Background Fournier’s gangrene is a rare form of necrotizing fasciitis that affects the genital area up to the perineal region and sometimes the abdominal wall. Objectives Our article aims to show that in the treatment of extensive forms of Fournier’s gangrene, correct use of flap and skin grafts and a quick reconstruction of the exposed tissues avoid scarring retraction of the testicles and deformation of the penis. Materials and methods We retrospectively reviewed the clinical and photographic data of Fournier’s gangrene cases treated at our Institute. The data were evaluated to obtain an estimate of the results of the reconstructive technique used, in terms of percentage of occurred healings and eventual complications. Results A total of 34 patients underwent surgery for Fournier’s gangrene. In nine cases (26.5%), we had minor complications: in four patients, suffering from diabetes and obesity, a retard in attachment of graft occurred, while in five patients with perianal problems there was a delay in healing due to the onset of local infection. Conclusion The reconstruction approach described here may reduce surgical times. In Fournier’s gangrene, the exposed tissues must be reconstructed as quickly as possible.

A Retrospective Case Series in Fournier’s Disease: And Its Emergency Management et Grafting Technique for Penis Coverage

“…This type of complication is frequently observed in patients suffering from diabetes and obesity, which are known to be risk factors for delayed wound healing [ 26 , 27 ]. We believe that to achieve an adequate penile reconstruction following Fournier's gangrene it is necessary that the exposed granulation tissue is sane and exempted from infectious necrotic residue [ 28 – 30 ]. It can be explained by the fact that very extensive gangrene needs longer local wound care to achieve an adequate infection-free state to receive the graft.…”