Fournier's gangrene. Review of reconstructive options

Ínsua-Pereira, Inês; Ferreira, Pedro; Teixeira, Sérgio; Barreiro, Diogo; Silva, Álvaro

doi:10.5173/ceju.2020.0060

Cited by 26 publications

(24 citation statements)

References 38 publications

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“…The presence of subcutaneous gas in the perineum and the scrotal area appears as a "dirty" acoustic shadowing on US imaging [48]. The most specific imaging modality for determining the extent of infection is computed tomography (CT), which allows surgical teams to plan debridement accordingly [49]. When other imaging modalities are insufficient to determine the extent of infection, magnetic resonance imaging (MRI) is used [48].…”

Section: Evaluation Of Fournier's Gangrenementioning

confidence: 99%

Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review

Lewis¹,

Majeed²,

Olang³

et al. 2021

Cureus

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Fournier's gangrene (FG) is a perineal and abdominal necrotizing infection. It is most commonly found in middle-aged men with comorbidities such as diabetes mellitus. Initial symptoms are often indistinct and can rapidly progress to overwhelming infections with a relatively high mortality rate. It is crucial to make a prompt diagnosis so that the patient receives appropriate treatment. Given the importance of the identification of FG, we explored what were the most common signs and symptoms associated with FG, as well as distinguished the gold standard treatment. This systematic review utilized articles identified exclusively through PubMed using key terms such as Fournier's gangrene, signs, symptoms, and treatment. A total of 37 studies, including a total of 3,224 patients (3,093 males and 131 females), fit our inclusion parameters for relevance that included either the most identifiable presentation of FG or the most effective treatment. From our search, the most common clinical presentation was scrotal and labial pain, fever, abscesses, crepitus, erythema, and cellulitis. Diagnosis is made from clinical findings in conjunction with imaging. The gold standard for treatment was found to be a combination of surgical debridement, broadspectrum antibiotics, and the administration of intravenous fluids. Further, patient survival was found to be directly related to the time from diagnosis to treatment when they underwent surgical debridement. The importance of early identification for improved outcomes or survival highlights the need for further studies or measures to enhance the identification of the signs and symptoms of FG.

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Section: Evaluation Of Fournier's Gangrenementioning

confidence: 99%

Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review

Lewis¹,

Majeed²,

Olang³

et al. 2021

Cureus

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“…The more seldom extrapelvic route of VRAM flap transfer has been described in cases where laparotomy is not necessary for tumor resection [15]. In the case of perineal defects due to Fournier gangrene, the VRAM flap has only been used for extensive defects due to its bulkiness [16,17].…”

Section: Introductionmentioning

confidence: 99%

Personalized Reconstruction of Genital Defects in Complicated Wounds with Vertical Rectus Abdominis Myocutaneous Flaps including Urethral Neo-Orifice

Horch

Ludolph

Arkudas

et al. 2021

JPM

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Non-healing extensive wounds in the perineal region can lead to severe soft tissue infections and disastrous complications, which are not manageable with conservative measures. Specifically in recurrent or advanced pelvic malignancies, irradiation often leads to extensive scarring and wound breakdown, resulting in significant soft tissue defects during surgical tumor excision. Among several surgical options to reconstruct the perineum, the transpelvic vertical rectus abdominis myocutaneous (VRAM) flap has proven to be one of the most reliable methods. Specific modifications of this flap allow an individualized procedure depending on the patient’s needs. We modified this technique to include the urethral orifice into the skin paddle of VRAM flaps in three patients as a novel option to circumvent urinary diversion and maintain an acceptable quality of life.

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“…Por otro lado, el injerto de piel parcial autólogo es una de las técnicas más frecuentemente utilizadas, debido a su seguridad y versatilidad, así como la extensa disponibilidad de zona donante (7). El proceso consiste en la obtención de una porción de piel de un grosor aproximado de 0.2-0.4mm, tomado de una zona do-nante, preferentemente los muslos, que es obtenido con un dermatomo, tras lo cual el injerto es mallado, lo que permite aumentar su extensión y por tanto aumentar la superficie a cubrir.…”

Section: Introductionunclassified

“…Finalmente, la cobertura mediante colgajo, ya sea fasciocutáneo o miocutáneo, consiste en la transposición de tejido desde una zona colindante al defecto hacia el mismo, preservando un pedículo unido a la zona donante original, a través del cual se garantiza la vascularización y, en algunos casos, la inervación. Representa una opción que, aunque puede resultar fiable, como contrapartida presenta mayor afectación de la zona donante, así como mayor complejidad quirúrgica (7).…”

Section: Introductionunclassified

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Surgical treatment of Fournier’s Gangrene: debridement and coverage. Series of 7 cases

et al. 2021

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Introduction: Fournier’s disease is a type of necrotizing fasciitis, which is quickly progressive and involves mainly the testicular, perineal and perianal areas. Its etiology is polymicrobial, being associated to multiple risk factors.Due to its complexity, its treatment comprises antibiotic therapy, as well as two surgical steps, including the first one various surgical interventions, which consist in aggressive debridement of the nonviable tissue, and a second step, in which the coverage of the resulting defect is undertaken, for which multiple surgical techniques are available, although it has not been clarified which one should be indicated. Objectives: To find out which surgical techniques are used for coverage in Fournier’s disease and the length of the hospital stay that each one associates, as well as the characteristics of the patients with this disease. Material and methods. We selected all the patients whose diagnosis was Gangrene Fournier when discharged form hospital, who also underwent surgical coverage of the resulting defect in the Department of Plastic and Reconstructive Surgery in Hospital Reina Sofía of Córdoba, Spain. From these patients, we recollected data about the coverage surgical technique undertaken, length of the hospital stay, demographic characteristics of the patients, associated risk factors, possible precipitating factors, as well as anatomical affected areas. Subsequently, absolute and relative frequencies were calculated. Results. Most patients were middle-advanced aged males. The perineal area was the most common affected one. The most usual risk factors were hypertension and smoking. The split-thickness skin graft was the coverage technique most frequently used. Conclusions. Fournier’s disease is potentially severe illness which requires a multidisciplinary approach, involving multiple surgical operations, as well as a long hospital stay. The coverage surgery presents high heterogeneity, being primary closure, secondary closure, split-thickness skin graft and fascio/musculocutaneous flap considered among the surgical techniques available.

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Fournier's gangrene. Review of reconstructive options

Cited by 26 publications

References 38 publications

Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review

Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review

Personalized Reconstruction of Genital Defects in Complicated Wounds with Vertical Rectus Abdominis Myocutaneous Flaps including Urethral Neo-Orifice

Surgical treatment of Fournier’s Gangrene: debridement and coverage. Series of 7 cases

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