MP15-13 FAVORABLE SAFETY OUTCOMES OF DELAYED PRIMARY CLOSURE OF LARGE FOURNIER’S GANGRENE SKIN DEFECTS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP15-13 FAVORABLE SAFETY OUTCOMES OF DELAYED PRIMARY CLOSURE OF LARGE FOURNIER’S GANGRENE SKIN DEFECTS Sailakshmi Senthil Kumar, Helen Sun, Nicholas Sellke, Kimberly Tay, Donald Bodner, Shubham Gupta, Kirtishri Mishra, and Kyle Scarberry Sailakshmi Senthil KumarSailakshmi Senthil Kumar More articles by this author , Helen SunHelen Sun More articles by this author , Nicholas SellkeNicholas Sellke More articles by this author , Kimberly TayKimberly Tay More articles by this author , Donald BodnerDonald Bodner More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Kirtishri MishraKirtishri Mishra More articles by this author , and Kyle ScarberryKyle Scarberry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fournier’s gangrene (FG) is a necrotizing infection of the male genitalia associated with significant loss of genital tissue. Traditionally, loss of >50% of scrotal skin is thought not to be amenable to primary closure and is often left to heal by secondary intention due to concern for infection recurrence. We hypothesize that delayed primary closure (DPC) for FG patients is feasible and safe for large skin defects. METHODS: A single institution retrospective review was done from October 2020 to October 2022 of adult males that underwent DPC for FG. Patients were assessed for overall stability at serial debridements and a healthy wound bed prior to closure. All patients had minimum follow-up at 1 and 4 weeks for drain removal and wound check. Additional follow-ups were scheduled as needed. Clinical data including demographics, medical history, length of stay, operative details, and complications were collected. RESULTS: We identified 13 patients that underwent DPC. Average age was 61.3 years and average BMI was 36.2 kg/m2. The majority of patients had hypertension and/or diabetes mellitus (84.6%). Median number of FG debridements was 2 (IQR 2-3), with a median time to closure of 6 days (IQR 3-11) and length of stay of 11 days (IQR 9-16). Average genital defect size was 119 cm2 (range 44-346 cm2). Five patients (38.4%) were closed using scrotal flaps alone; other closures used advancement flaps from the inner thigh, lower abdomen, and perineum. There were 4 Clavien-Dindo III complications: 2 partial flap necrosis, 1 wound dehiscence, and 1 instance of bleeding. Three were successfully managed by re-exploration and re-closure. One flap failure occurred in a patient with pre-existing radiation and rectourethral fistula. After re-closure attempt, the wound re-opened and was left to heal by secondary intention. The majority of patients were able to be discharged home directly (69.2%). At an average follow-up of 3.5 months, 46.2% of patients had no known complications. One patient (7.7%) experienced superficial genital cellulitis at 6.5 weeks post-op which was successfully managed with antibiotics. CONCLUSIONS: Our data from a single institution shows that DPC is safe and effective with few infectious sequelae. Patients with large defects may benefit from less complex wound management requirements and discharge directly to home. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e197 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sailakshmi Senthil Kumar More articles by this author Helen Sun More articles by this author Nicholas Sellke More articles by this author Kimberly Tay More articles by this author Donald Bodner More articles by this author Shubham Gupta More articles by this author Kirtishri Mishra More articles by this author Kyle Scarberry More articles by this author Expand All Advertisement PDF downloadLoading ...