Reconstruction after Fournier gangrene: Our approaches and outcomes

Abstract

Context: Fournier's gangrene is a necrotizing infection of the perianal region and scrotum. It progresses quite quickly and is fatal. Treatment involves debridement of the necrotized tissues, broad-spectrum antibiotherapy, and fluid replacement therapy. Delayed reconstruction can be planned after clinical stabilization. While there is a wide range of reconstruction options, no ideal method is applicable to all patients. Aims: By presenting our results for Fournier's gangrene reconstruction surgery at our center, we aim to discuss surgical approaches for the condition, and their pros and cons. Settings and Design: Retrospective analysis. Subjects and Methods: Sixteen patients who underwent Fournier's gangrene reconstruction in 2014–2018 at Balikesir Ataturk City Hospital were analyzed retrospectively. The mean age, defect size and location, concomitant diseases, mean time to reconstruction, reconstruction method, hospital stay after reconstruction, and complication rates were reported. Results: All patients were male. The most common comorbidity was diabetes mellitus (75%). The mean time to reconstruction was 48.4 days. Scrotal flap alone was the most common reconstruction method (56.25%). Bilateral superomedial thigh flap was used in four patients with total scrotal defect (25%). Gracilis musculocutaneous flap was combined with scrotal flap for three patients (18.75%), with defect extending to the perianal region. The mean hospital stay after reconstruction was 8.6 days. Two patients (12.5%) developed wound dehiscence. Conclusions: No ideal method is applicable to all patients. Rather, the patient age, expectations, and general condition; defect characteristics; and the surgeon's experience determine the ideal method.