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Fournier gangrene - would you KISS it?
Miguel João Ribeiro Matias1, Diogo Guimarães1, Manuel Vilela1
1Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
Abstract:
Fournier gangrene is a disease characterized by necrotizing fasciitis of the perineal and genital region, resulting from synergistic polymicrobiotic infection. Most infections can be localized to a cutaneous, urethral, or rectal source and can culminate in a fulminant sepsis. Current state of the art is systemic broad-spectrum antibiotics and serial aggressive debridement which result in superficial perineal defect of wide dimensions. We compiled all the cases of Fournier gangrene that required reconstruction after debridement in Centro Hospitalar Universitário Lisboa Central from 2018 to 2022. Inclusion criteria were reconstruction for Fournier defects and patients' age 18 to 90 years old. Exclusion criteria were patients who didn't require reconstruction or didn't complete it due to death or transfer to another healthcare institution. Reconstructive procedures and complication rates are reported as whole numbers and percentages of total. The initial search yielded 32 patients. There were 2 (6.2%) patients with defects that healed by secondary intention, 6 (18.7%) with delayed primary closure, 4 (12.5%) with implantation of the testicle in a medial thigh pocket, 12 (37.5%) with skin grafts, 4 (12.5%) with scrotal advancement flaps, 2 (6.2%) with flaps, and 2 (6.2%) with flaps and skin grafts in combination. Four outcomes were evaluated: number of patients, defect size, method of reconstruction, and wound-healing complications. Most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. The reconstructive options need to be patient tailored in order to achieve long lasting results with a minimum of postoperative morbidity.
Insights
Fournier gangrene reconstruction after debridement involves various techniques like skin grafts and flaps. Patient-tailored approaches are crucial for optimal outcomes and minimal complications in managing these extensive genital defects.
Area of Science:
- Urology
- Plastic Surgery
- Infectious Diseases
Background:
- Fournier gangrene is a severe necrotizing fasciitis of the perineogenital region.
- It stems from polymicrobial infections, often originating from cutaneous, urethral, or rectal sources.
- Aggressive debridement is standard, frequently leaving large superficial perineal defects requiring reconstruction.
Purpose of the Study:
- To review reconstructive procedures for Fournier gangrene defects.
- To analyze complication rates associated with different reconstruction methods.
- To evaluate the effectiveness of various techniques in achieving functional and cosmetic restoration.
Main Methods:
- Retrospective compilation of Fournier gangrene cases requiring reconstruction at Centro Hospitalar Universitário Lisboa Central (2018-2022).
- Inclusion criteria: patients aged 18-90 requiring reconstruction; exclusion criteria: no reconstruction needed or incomplete due to death/transfer.
- Analysis of reconstructive procedures, defect sizes, and wound-healing complications.
Main Results:
- Thirty-two patients were included, with defects reconstructed via secondary intention (6.2%), delayed primary closure (18.7%), testicular implantation in thigh pockets (12.5%), skin grafts (37.5%), scrotal advancement flaps (12.5%), flaps (6.2%), and combined flaps/skin grafts (6.2%).
- Most techniques provided reliable coverage and testicular protection with acceptable cosmetic results.
- Wound-healing complications were evaluated across all reconstructive methods.
Conclusions:
- Various reconstructive techniques can effectively manage Fournier gangrene defects.
- Patient-tailored reconstructive strategies are essential for achieving long-lasting results.
- Minimizing postoperative morbidity is a key consideration in selecting the optimal reconstructive approach.
