Initial Management and Reconstructive Surgery Algorithm for Fournier Gangrene

To report our single institution multidisciplinary step-by-step management of Fournier gangrene and specifically focus on our surgical reconstructive strategy.

This was a retrospective single-arm monocentric study including all consecutive Fournier gangrene treated at our institution between May 2001 and February 2020. Data on initial management, including urological care, resuscitation in collaboration with the infectious disease unit, and reconstructive strategies based on defects location, were collected. Patient self-reported functional and aesthetical results were assessed using a 5-point Likert scale.

Overall, 45 patients were included in this study. All patients had surgical debridement on admission and 26 (57.8%) required repeated surgical debridement. Additional surgical procedures were colostomy in 31 (68.9%) cases, suprapubic catheter in 5 (11.1%) cases, orchiectomy in two cases, and penectomy for one patient. Overall, 14 (31.1%) patients had septic shock and required active resuscitation. Following surgical debridement, vacuum-assisted closure was used in 19 (42.2%) patients. No patient died. Thirty-six (80%) patients had reconstructive surgery. The median time from admission to reconstruction procedure was 37.5 days (range: 11-70). According to our reconstructive algorithm, reconstruction of the penile, scrotum, medial thigh, suprapubic, and the anal area was performed in respectively 19 (52.8%), 18 (50%), 11 (30.6%), 3 (8.3%), and 2 (5.6%) cases. Aesthetic and functional results of reconstruction were reported to be satisfying or extremely satisfying by 15 (71%) of the 21 patients who could be contacted.

Multidisciplinary step-by-step management of Fournier gangrene including our reconstruction approach based on lesion extension can be achieved with minimal mortality and with good results for the patients.