Coverage of External Genitalia and Perineal Defects after the Fournier’s Gangrene

Abstract

Introduction: We report the experience of the National Center of Burns and Plastic Surgery of Ibn Rochd University Hospital of Casablanca in the coverage of defects secondary to Fournier’s gangrene. Materials and Methods: We retrospectively collected and analyzed clinical, therapeutic, and scalable data of patients referred for perineal coverage after Fournier's gangrene, during a period of 3 years (from January 2018 to December 2020), including age, gender, medical background, Charlson comorbidities index; cause, period of coverage, Performance Status score, the extent of the defect and affected sites, Anesthesia, Surgical technique, and post-operative suites. Results: 46 patients were identified: 43 males (93%) and 3 females (7%); mean age was 53 years. Diabetes was the most common comorbidity (58%). The major cause was proctologic (60.9%). The average consultation time was 44.15 days. The patients presented with defects measuring between 4 cm2 and 800 cm2, mostly affecting the scrotum (80%). Several surgical techniques have been employed and added together, depending on the extent and topography of the defect. 20 were treated by suturing due to sufficient skin laxity, 13 were covered by skin grafting of the penis and/or for an extensive and/or oozing defect. 20 were covered by a scrotal advancement flap for a defect not exceeding half of the scrotum. The fascio-cutaneous flaps, namely the VY advancement flap was performed in 14 patients (uni or bilateral), and the medial thigh flap which was performed in 3 patients, for defects involving the perineum and/or more than half of the scrotum. Seven patients (15.21%) presented coverage technique complications. Conclusion: Adequate coverage of the perineum and external genitalia after the Fournier's gangrene prevents functional sequelae and reduces aesthetic sequelae.