Retalho fasciocutâneo de região interna de coxa para reconstrução escrotal na síndrome de Fournier

Abstract

Fournier syndrome is a severe disease that should be treated aggressively with debridement and broad-spectrum antibiotics. It usually causes loss of a large area of tissue and may spread to other areas beyond the perineum such as the abdomen, lower limbs, dorsum, chest, and retroperitoneum. The loss of the scrotum is a common condition in this pathology. Two cases of scrotum reconstruction with the fasciocutaneous flap of the inner thighs with excellent recovery, good aesthetic results, and few complications are reported.

Síndrome de Fournier: 10 anos de avaliação

“…A polymicrobial flora is usually found, including gram-ne gative bacteria (e.g., Escherichia coli, Proteus mi rabilis, Klebsiella sp., Pseudomonas, Bacteroides sp., Aci netobac ter sp. ), gram-positive bacteria (e.g., staphylococci, streptococci, enterococci, and Clostridium), and fungi [12][13][14][15] (Table 1). Contemporary case series indicate that Fournier's syndrome usually affects patients between the third and sixth decades of life with comorbidities such as debilitating conditions (e.g., malnutrition and sepsis); immunosuppression (e.g., diabetes mellitus, chronic alcoholism, underlying malignancy, AIDS, measles, chemotherapy, and leukemia); colorectal and urogenital diseases; postoperative complications (associated with urologic instrumentation use, herniorrhaphy, hemorrhoidectomy, orchiectomy, and prostatectomy), intravenous drug use; and trauma (e.g., local, mechanical, technical, and chemical) including bites, scratches, and vaginal and anal intercourse [15][16][17] .…”

Scrotal reconstruction with superomedial fasciocutaneous thigh flap

“…Mauro 16 points out that this flap is technically simple, rarely shows ischemia, and provides excellent esthetic results. As a disadvantage, one can consider the limitation of the cross-sectional diameter and the skin elasticity of the medial thigh region.…”

Brazilian scientific evidence on Fournier’s gangrene

“…Fournier's gangrene was first described by Hippocrates in the fifteenth century b.C, as a complication of erysipelas. Fournier's gangrene is a synergic necrotizing fasciitis of the perineum and of the abdominal wall, which has its origin the scrotum and in the penis, in the case of men, and in the vulva and groin, in the case of women (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) . The causes of Fournier's gangrene can also be associated to cuts, burns, abrasions, lacerations, contusions, animal bites, insect bites and subcutaneous and intravenous injections.…”

“…The synergic action of aerobic and anaerobic bacteria can be responsible for the frequent and fulminant evolution of the disease (16,21) . The quantitative and the types of microorganisms involved in Fournier's gangrene will be intimately related to the site of the infection, especially if it is on the abdominal wall, extremities and perineal.…”

“…The early recognition of the infection associated to an aggressive and invasive treatment are essential measures to decrease those cases. As to the quality of life, the skin grafting or fasciocutaneous flap are satisfactory alternatives (9,13,16) .…”