Reconstruction of scrotal and perineal defects in Fournier’s gangrene

Summary 

Background

Fournier’s gangrene is an acute and potentially lethal necrotising fasciitis that involves the scrotum and perineum. This disease can result in the loss of skin and soft tissue. To repair the scrotal and perineal defects remains a surgical challenge.

Methods

Between January 2000 and December 2008, 50 patients were admitted to our hospital with a diagnosis of Fournier’s gangrene. We retrospectively reviewed 31 of the 44 surviving patients, who needed reconstructive procedures for coverage of scrotal and perineal soft-tissue defects. The choice of reconstructive procedure was based on the size, location, severity of the defects and the availability of local tissue. The patients’ age, predisposing factors, defect size and location, reconstructive procedures and outcomes were reviewed.

Results

The mean age of the patients was 53.6 years (range, 20–84 years). The average size of the skin defect was 86cm². A total of 12 patients were treated by scrotal advancement flap coverage, nine by split-thickness skin graft, five by pudendal thigh flap, two by gracilis myocutaneous flap, one by gracilis muscle flap plus split-thickness skin graft and three by pedicle anterolateral thigh flap. The overall surgical complication rate was 16%.

Conclusions

Early debridement and wound coverage in Fournier’s gangrene are mandatory to allow patients to return to normal life. We set up a valuable reconstructive algorithm based on the characteristics of the defects and our 9 years of experience, which adds to the versatility of the armamentarium of the reconstructive surgeon.

Keywords: Fournier’s gangrene, Scrotal and perineal defects, Anterolateral thigh flap, Scrotal advancement flap, Skin graft