Initial Management and Reconstructive Surgery Algorithm for Fournier Gangrene.

Area of Science:

• Urology
• Infectious Diseases
• Plastic Surgery

Background:

• Fournier gangrene is a rapidly progressive, polymicrobial infection of the perineum and genitalia.
• Prompt diagnosis and aggressive management are crucial for patient survival and minimizing morbidity.

Purpose of the Study:

• To outline a single-institution, multidisciplinary management protocol for Fournier gangrene.
• To specifically detail a stepwise surgical reconstructive strategy based on the extent of tissue damage.

Main Methods:

• Retrospective analysis of consecutive Fournier gangrene cases (May 2001-February 2020).
• Data collection included initial management, urological care, resuscitation, and reconstructive techniques.
• Patient-reported functional and aesthetic outcomes were assessed using a Likert scale.

Main Results:

• 45 patients were included; 57.8% required repeat debridement.
• 80% underwent reconstructive surgery, with a median time of 37.5 days post-admission.
• Reconstruction addressed penile, scrotal, thigh, suprapubic, and anal defects.
• 15 of 21 contacted patients reported satisfying or extremely satisfying aesthetic and functional results.
• No patient mortality was observed.

Conclusions:

• A multidisciplinary, step-by-step management approach for Fournier gangrene is effective.
• The described reconstructive algorithm, tailored to lesion extension, leads to good patient outcomes with minimal mortality.