Introduction
Fournier's gangrene is a urological emergency, comprising of type I necrotizing fasciitis resulting in anatomic defects affecting the perineum, perianal region, and external genitalia in both men and women, often requiring reconstruction.
Objectives
The aim of this article is to provide a comprehensive review of the different reconstructive techniques for Fournier's gangrene.
Methods
A literature search was performed on PubMed with the search terms “Fournier”s gangrene” “genital reconstruction” and “Fournier's gangrene phalloplasty.” The European Association of Urology's guidelines on Urological infections were also consulted for recommendations.
Results
Reconstructive procedures include primary closure, scrotal advancement flaps, fasciocutaneous flaps, myocutaneous flaps, skin grafts, and phalloplasty. There is insufficient evidence to support that flaps lead to better outcomes than skin grafts, or vice versa, particularly for scrotal defects. Both techniques have been shown to have satisfactory aesthetic results, with good skin color match and natural scrotal contour. With regards to phalloplasty, there is a lack of data specifically relating to Fournier's gangrene, as most articles were addressed toward gender affirmation surgery. Furthermore, there is a lack of guidelines in both the immediate and reconstructive management of Fournier's gangrene. Lastly, the outcomes reported following reconstructive surgery have been objective rather than subjective, meaning that patient satisfaction was rarely recorded.
Conclusion
Further research is required in the field of reconstructive surgery specific to Fournier's gangrene, which should also take into consideration patient demographics and subjective reports regarding cosmesis and sexual function.
Objectives: Regular video game playing has been linked with obesity, but the underlying mechanisms remain unclear. Drawing on evolutionary life history theory, we hypothesized that playing violent video games, through activating the stress response, might increase the immediate demand for fuel by muscle and brain tissue, resulting in elevated appetite and food consumption. Methods: We randomized 71 young adult men to play video games, involving either violent content or nonviolent puzzle-solving, for 1 h. Over this period, we measured stress markers (blood pressure [BP], heart rate, visual-analogue scale [VAS] self-ratings), muscle function (handgrip strength) and cognitive function (memory recall test).Appetite was assessed by VAS, and by food intake using a test-meal after the intervention. Linear mixed-effects models were fitted to assess group effects and group: time effects.Results: During the intervention, the violent video game group showed elevated systolic BP (Δ = 4.7 mm Hg, 95% CI 1.0, 8.4) and reported feeling more alert but less calm or happy. They showed no difference in grip strength or memory recall. They reported lower feelings of "fullness" but consumed similar food-energy during the test-meal.Conclusions: Although playing a video game with violent content elevated physiological and perceived stress markers compared with a nonviolent game, this was not associated with markers of altered fuel distribution toward two tissues (muscle and brain) that contribute to the "fight-or-flight" response. Rather than more energy being allocated to the brain overall, energy may have been reallocated within the brain. This may explain why there was no compensatory increase in energy intake in the violent video game group.
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