Fournier?s gangrene - delayed pedicle flap based upon the anterior abdominal wall

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Introduction: Fournier's gangrene is a poly-microbial necrotizing fasciitis that involves the perineum and/or external genitalia. Urgent surgical debridement is well recognized as essential acute treatment yet unique challenges arise for plastic surgical reconstruction to obtain a complete functional recovery. This case describes a successful delayed pedicle flap repair based upon the anterior abdominal wall.Case description: A 24 year old man was admitted to ICU ten days after elective circumcision with Fournier's gangrene. He underwent a number of surgical debridements, and was referred for plastic surgical management. He had penile reconstruction using a random pattern abdominal flap, which was performed as a three stage procedure including flap vascular delay technique. Discussion: Perineal and penile skin loss can be significant and is difficult to repair. Various techniques have been used to reconstruct lost tissue: skin grafts, transposition of the testes and spermatic cords to the thigh, flaps, and other types of pediculated myocutaneous flaps. Muscle flap reconstruction provides an environment that allows for complete regeneration of the urethral epithelium but is bulky and unsightly. Skin grafts contract and may produce painful and dysfunctional reconstructions. This novel technique produces a functional, and aesthetic reconstruction. Conclusion: Penile skin recovery following Fournier's gangrene recovery is problematic. This case demonstrates the functionality of a delayed flap repair using the anterior abdominal wall.

Systematic review of complications arising from male circumcision

“…Skin bridges (penile skin adhesion) Neonatal circumcision: New recommendations & implications for practice 1 Dermatological complications of circumcision: Lesson learned from cases in a pediatric dermatology practice 61 Complications of circumcision 27 Surgically correctable morbidity from male circumcision: Indications for specialist surgical care in Lagos 43 The relationship between obesity and complications after neonatal circumcision 76 Rates of complications after newborn circumcision in a well-baby nursery, special care nursery, and neonatal intensive care unit 29 Circumcision-related tragedies seen in children at the Komfo Anokye Teaching Hospital, Kumasi, Ghana 38 34. Fournier's gangrene Fournier's gangrene-delayed pedicle flap based upon the anterior abdominal wall 86 Fournier's gangrene after adult male circumcision 87 35. Penile mycosis leading to penile gangrene Devastating penile mycosis leading to penile gangrene 88 36.…”

Skin‐sparing approach in the management of Fournier's gangrene: the initial histological evidence and results of a tertiary health‐care center

“…Early recognition of the clinical situation, urgent surgical treatment, improved postoperative follow‐up with recurrent debridement and revisions, broad spectrum antibiotic therapy, proper fluid resuscitation and modern wound‐care techniques has led to better results and some contemporary series have achieved a zero mortality 2 . After radical debridement of the tissues, reconstructive techniques were frequently required 3,4 . However, contemporary practice has focused on rational sparing of the tissue to provide a sufficient coverage for the delayed primary closure 5 .…”

“…2 After radical debridement of the tissues, reconstructive techniques were frequently required. 3,4 However, contemporary practice has focused on rational sparing of the tissue to provide a sufficient coverage for the delayed primary closure. 5 Considering the traditional place of wound revisions and re-debridement in the management of FG, the skin and soft tissue sparing strategy seems reasonable for both elimination of infected and necrotic tissues and facilitating the closure.…”

Perfil clínico de pacientes com Síndrome de Fournier em um hospital terciário

“…A Síndrome de Fournier se relaciona a diversas comorbidades, sendo a mais descrita a Diabetes Mellitus, além da obesidade, tabagismo e hipertensão arterial5,10 . São listados ainda o alcoolismo e doenças imunossupressoras, que não aparecem nesta série11 .…”