Reconstruction of Scrotal and Perineal Defects in Fournier’s Gangrene
Author(s)
Hakim Chabak*,
Amine Rafik,
Mohammed Ezzoubi,
Mounia Diouri,
Naïma Bahechar,
Abdessamad Chlihi
Affiliation(s)
National Center of Burns and Plastic Surgery, Ibn Rochd University Hospital, Casablanca, Morocco.
National Center of Burns and Plastic Surgery, Ibn Rochd University Hospital, Casablanca, Morocco.
ABSTRACT
Fournier’s gangrene described in 1883 by Jean Alfred Fournier, still poses ethiopathogenic, evolutive and therapeutic problems. This is a therapeutic emergency; early diagnosis, medical and surgical treatments contribute to reducing mortality rate. Tissue defect engendered by infection and/or by its excision requires morphological and functional reconstruction. The choice of the reconstruction technique depends on several parameters: early or delayed coverage, the size of the defect, the local capital skin and the patient’s general condition. Through this study involving 95 cases of scrotal and perineal gangrene treated at the National Center of Burns and Plastic Surgery of Ibn Rochd University Hospital of Casablanca over a period of 10 years (2004-2014), we report our approach in the surgical management of defect secondary to Fournier’s gangrene.
Fournier’s gangrene described in 1883 by Jean Alfred Fournier, still poses ethiopathogenic, evolutive and therapeutic problems. This is a therapeutic emergency; early diagnosis, medical and surgical treatments contribute to reducing mortality rate. Tissue defect engendered by infection and/or by its excision requires morphological and functional reconstruction. The choice of the reconstruction technique depends on several parameters: early or delayed coverage, the size of the defect, the local capital skin and the patient’s general condition. Through this study involving 95 cases of scrotal and perineal gangrene treated at the National Center of Burns and Plastic Surgery of Ibn Rochd University Hospital of Casablanca over a period of 10 years (2004-2014), we report our approach in the surgical management of defect secondary to Fournier’s gangrene.
Cite this paper
Chabak, H. , Rafik, A. , Ezzoubi, M. , Diouri, M. , Bahechar, N. and Chlihi, A. (2015) Reconstruction of Scrotal and Perineal Defects in Fournier’s Gangrene. Modern Plastic Surgery, 5, 23-27. doi: 10.4236/mps.2015.53005.
Chabak, H. , Rafik, A. , Ezzoubi, M. , Diouri, M. , Bahechar, N. and Chlihi, A. (2015) Reconstruction of Scrotal and Perineal Defects in Fournier’s Gangrene. Modern Plastic Surgery, 5, 23-27. doi: 10.4236/mps.2015.53005.
References
[1] Eke, N. (2000) Fournier’s Gangrene: A Review of 1726 Cases. British Journal of Surgery, 87, 718-728.
http://dx.doi.org/10.1046/j.1365-2168.2000.01497.x [2] Sorensen, M.D., Krieger, J.N., Rivara, F.P., Klein, M.B. and Wessells, H. (2009) Fournier’s Gangrene: Management and Mortality Predictors in a Population Based Study. Journal of Urology, 182, 2742-2747.
http://dx.doi.org/10.1016/j.juro.2009.08.050 [3] Ozkan, O.F., et al. (2014) Fournier’s Gangrene Current Approaches. International Wound Journal.
http://dx.doi.org/10.1111/iwj.12357 [4] Lipsker, A., et al. (2014) Gangrène de Fournier: Prise en chargechirurgicale. Progrès FMC, 24, F80-F85.
http://dx.doi.org/10.1016/j.fpurol.2014.06.001 [5] Boukind, H., Ezzoubi, M. and Chafiki, N. (1995) La reconstruction scrotale après cellulite nécrosante du périnée et des organes génitaux externes: A propos de 21 cas. Annales d’Urologie, 9, 309-312. [6] Czymek, R., Kujath, P., Bruch, H.P., Pfeiffer, D., Nebrig, M., Seehofer, D. and Guckelberger, O. (2013) Treatment, Outcome and Quality of Life after Fournier’s Gangrene: A Multicenter Study. Colorectal Disease, 15, 1529-1536.
http://dx.doi.org/10.1111/codi.12396 [7] Chen, S.Y., Fu, J.P., Chen, T.M. and Chen, S.G. (2011) Reconstruction of Scrotal and Perineal Defects in Fournier’s Gangrene. Journal of Plastic, Reconstructive Aesthetic Surgery, 64, 528-534.
http://dx.doi.org/10.1016/j.bjps.2010.07.018 [8] Maguina, P., Palmieri, T.L. and Greenhalgh, D.G. (2003) Split Thickness Skin Grafting for Recreation of the Scrotum Following Fournier’s Gangrene. Burns, 29, 857-862.
http://dx.doi.org/10.1016/j.burns.2003.07.001 [9] Hanasono, M.M., Skoracki, R.J. and Yu, P. (2010) A Prospective Study of Donor Site Morbidity after Anterolateral Thigh Fasciocutaneous and Myocutaneous Free Flap Harvest in 220 Patients. Plastic and Reconstructive Surgery, 125, 209-214.
http://dx.doi.org/10.1097/PRS.0b013e3181c495ed [10] Karsidag, S., Akcal, A., Sirvan, S.S., Guney, S. and Ugurlu, K. (2011) Perineoscrotal Reconstruction Using a Medial Circumflex Femoral Artery Perforator Flap. Microsurgery, 31, 116-121.
http://dx.doi.org/10.1002/micr.20839 [11] Mauro, V. (2011) Fasciocutaneous Flap of the Inner Thigh for Scrotal Reconstruction in Fournier Syndrome. Revista Brasileira de Cirurgia Plástica, 26, 707-709.
http://dx.doi.org/10.1590/S1983-51752011000400030 [12] Yang, J., Ko, S.H., Oh, S.J. and Jung, S.W. (2013) Reconstruction of a Perineoscrotal Defect Using Bilateral Medial Thigh Fasciocutaneous. Archives of Plastic Surgery, 40, 72-74.
http://dx.doi.org/10.5999/aps.2013.40.1.72 [13] Cannistra, C., Kirsch-Noir, F., Delmas, V., Marmuse, J.-P. and Boccon-Gibod, L. (2003) La reconstruction du scrotum après gangrène de Fournier par lambeau inguinal. Progrès en Urologie, 13, 703-706. [14] Crane, C., Cornejo, A., Lyons, R. and Alter, G.J. (2013) Urethral Reconstruction Using a Prefabricated Pedicled Gracilis Flap. Annals of Plastic Surgery, 70, 691-693.
http://dx.doi.org/10.1097/SAP.0b013e3182414843 [15] Lee, S.H., Rah, D.K. and Lee, W. (2012) Penoscrotal Reconstruction with Gracilis Muscle Flap and Internal Pudendal Artery Perforator Flap Transposition. Journal of Urology, 79, 1390-1394.
http://dx.doi.org/10.1016/j.urology.2012.01.073 [16] Yanagi, M., Nishimura, T., Kondo, Y., Yamazaki, K., Sakai, S., Ishii, N., Kojo, K. and Hosoda, K. (2011) A Case of Fournier’s Gangrene Reconstructed Using a Rectus Abdominis Muscle Flap. Nihon Hinyokika Gakkai Zasshi, 102, 649-654.
http://dx.doi.org/10.5980/jpnjurol.102.649
[1] Eke, N. (2000) Fournier’s Gangrene: A Review of 1726 Cases. British Journal of Surgery, 87, 718-728.
http://dx.doi.org/10.1046/j.1365-2168.2000.01497.x [2] Sorensen, M.D., Krieger, J.N., Rivara, F.P., Klein, M.B. and Wessells, H. (2009) Fournier’s Gangrene: Management and Mortality Predictors in a Population Based Study. Journal of Urology, 182, 2742-2747.
http://dx.doi.org/10.1016/j.juro.2009.08.050 [3] Ozkan, O.F., et al. (2014) Fournier’s Gangrene Current Approaches. International Wound Journal.
http://dx.doi.org/10.1111/iwj.12357 [4] Lipsker, A., et al. (2014) Gangrène de Fournier: Prise en chargechirurgicale. Progrès FMC, 24, F80-F85.
http://dx.doi.org/10.1016/j.fpurol.2014.06.001 [5] Boukind, H., Ezzoubi, M. and Chafiki, N. (1995) La reconstruction scrotale après cellulite nécrosante du périnée et des organes génitaux externes: A propos de 21 cas. Annales d’Urologie, 9, 309-312. [6] Czymek, R., Kujath, P., Bruch, H.P., Pfeiffer, D., Nebrig, M., Seehofer, D. and Guckelberger, O. (2013) Treatment, Outcome and Quality of Life after Fournier’s Gangrene: A Multicenter Study. Colorectal Disease, 15, 1529-1536.
http://dx.doi.org/10.1111/codi.12396 [7] Chen, S.Y., Fu, J.P., Chen, T.M. and Chen, S.G. (2011) Reconstruction of Scrotal and Perineal Defects in Fournier’s Gangrene. Journal of Plastic, Reconstructive Aesthetic Surgery, 64, 528-534.
http://dx.doi.org/10.1016/j.bjps.2010.07.018 [8] Maguina, P., Palmieri, T.L. and Greenhalgh, D.G. (2003) Split Thickness Skin Grafting for Recreation of the Scrotum Following Fournier’s Gangrene. Burns, 29, 857-862.
http://dx.doi.org/10.1016/j.burns.2003.07.001 [9] Hanasono, M.M., Skoracki, R.J. and Yu, P. (2010) A Prospective Study of Donor Site Morbidity after Anterolateral Thigh Fasciocutaneous and Myocutaneous Free Flap Harvest in 220 Patients. Plastic and Reconstructive Surgery, 125, 209-214.
http://dx.doi.org/10.1097/PRS.0b013e3181c495ed [10] Karsidag, S., Akcal, A., Sirvan, S.S., Guney, S. and Ugurlu, K. (2011) Perineoscrotal Reconstruction Using a Medial Circumflex Femoral Artery Perforator Flap. Microsurgery, 31, 116-121.
http://dx.doi.org/10.1002/micr.20839 [11] Mauro, V. (2011) Fasciocutaneous Flap of the Inner Thigh for Scrotal Reconstruction in Fournier Syndrome. Revista Brasileira de Cirurgia Plástica, 26, 707-709.
http://dx.doi.org/10.1590/S1983-51752011000400030 [12] Yang, J., Ko, S.H., Oh, S.J. and Jung, S.W. (2013) Reconstruction of a Perineoscrotal Defect Using Bilateral Medial Thigh Fasciocutaneous. Archives of Plastic Surgery, 40, 72-74.
http://dx.doi.org/10.5999/aps.2013.40.1.72 [13] Cannistra, C., Kirsch-Noir, F., Delmas, V., Marmuse, J.-P. and Boccon-Gibod, L. (2003) La reconstruction du scrotum après gangrène de Fournier par lambeau inguinal. Progrès en Urologie, 13, 703-706. [14] Crane, C., Cornejo, A., Lyons, R. and Alter, G.J. (2013) Urethral Reconstruction Using a Prefabricated Pedicled Gracilis Flap. Annals of Plastic Surgery, 70, 691-693.
http://dx.doi.org/10.1097/SAP.0b013e3182414843 [15] Lee, S.H., Rah, D.K. and Lee, W. (2012) Penoscrotal Reconstruction with Gracilis Muscle Flap and Internal Pudendal Artery Perforator Flap Transposition. Journal of Urology, 79, 1390-1394.
http://dx.doi.org/10.1016/j.urology.2012.01.073 [16] Yanagi, M., Nishimura, T., Kondo, Y., Yamazaki, K., Sakai, S., Ishii, N., Kojo, K. and Hosoda, K. (2011) A Case of Fournier’s Gangrene Reconstructed Using a Rectus Abdominis Muscle Flap. Nihon Hinyokika Gakkai Zasshi, 102, 649-654.
http://dx.doi.org/10.5980/jpnjurol.102.649