Abstract
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. 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. 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. 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.
Highlights
Fournier’s gangrene is a poly-microbial necrotizing fasciitis that involves the perineum and/or external genitalia
Management involves urgent surgical debridement, which will usually need to be repeated, and may extend to total scrotectomy, and less commonly penectomy and colostomy. This case describes a successful delayed pedicle flap repair based upon the anterior abdominal wall
Several days after surgery he developed pain and swelling, became unwell and was admitted with sepsis at ICU with a fulminating infection and suppurative tissue necrosis. He underwent a series of emergency debridement. Three weeks after his acute infection he was referred for plastic surgical intervention
Summary
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. 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
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Schedule a callMore From: International braz j urol : official journal of the Brazilian Society of Urology
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