Two-stage Neoscrotum Reconstruction Using Porcine Bladder Extracellular Matrix after Fournier’s Gangrene

Abstract

Background: Fournier’s gangrene is a life-threatening infection. Survivors can be left with significant deformity of their external genitalia. We present our technique for restoring a more normal appearance to the scrotum. Methods: A 2-stage orchiopexy and scrotoplasty are performed. At the first stage, the testicles are delivered to their anatomic place and sutured together. Xenograft powder and wound matrix are used to stimulate a granulation response. After 2–3 weeks, split-thickness skin grafting is performed to create a neoscrotum. This is protected for 1 week with negative pressure wound therapy. Postoperatively, the scrotum is protected with nonstick dressings to prevent synechiae to the perineum. Results: Two to three weeks after product application, a robust granulation tissue bed can be seen, which is very receptive to a meshed skin graft scrotal pouch. Circumferential negative pressure wound therapy is safe and prevents synechiae of the scrotum to perineum. The scrotum healed without issue and demonstrated an acceptable aesthetic result. Conclusions: This technique produces a near-normal appearing scrotum in the normal anatomic position for the testicles. The porcine xenograft material incites an intense granulation reaction, producing a wound bed amenable to accept a skin graft at 2–3 weeks. This 2-stage procedure to create a neoscrotum can be considered for the reconstruction of disfigured genitalia from Fournier’s gangrene wounds.

Progress in Multidisciplinary Treatment of Fournier’s Gangrene

“…The lethal infection spreads rapidly from the genital area to the anterior abdominal wall and other important organs. 31,32 Platelet aggregation and complement fixation induced by aerobic bacteria together with heparanase and collagenase produced by anaerobic bacteria promotes the thrombosis of local microvessels and severe ischemia in this area, which eventually progresses to Fournier's gangrene. 4…”

“…the erythema color become deepen and bullae appear. 16,31,66,69,70 Because of the local nerve injury, the pain in the lesion is reduced. When combined with anaerobic infection, subcutaneous twisting and malodorous purulent drainage may occur, and the final skin manifestation is gangrene.…”

Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review

“…In the United States, Fournier’s gangrene (FG) is a rare and fatal form of necrotizing fasciitis, with an incidence rate of approximately 1.6 per 100,000 males [ 1 ]. Even with aggressive treatment, the current mortality rate for FG is approximately 40% [ 2 ], with literature estimates ranging from 20% to 80% [ 3 ]. FG is a rapidly spreading infection that spreads through the superficial and deep fascial layers in the perineal, genital, or perianal regions, causing multiple organ failure and septic shock.…”

“…These microbes collaborate to release enzymes that cause tissue necrosis [ 6 ]. The bacterial organisms that cause this necrotic infection release collagenases, which cause rapid tissue destruction at a rate of one inch per hour [ 3 ], allowing the infection to quickly spread from the genital region to the anterior abdominal wall and vital organs [ 7 ].…”

“…Even those who survive, suffer from sexual and urological disabilities, with debridement often necessitating multiple reconstructive surgeries [ 3 ]. Furthermore, these surgeries frequently necessitate tissue grafting as a means of reconstruction.…”