Comparison of two different surgical techniques in the treatment of Fournier’s Gangrene

Fournier’s gangrene is a rapidly progressive, fatal, necrotizing fasciitis of the perineum and penoscrotal region which requires rapid intervention. This retrospective study compares the surgical outcomes of the fasciocutaneous flap and the embedding of the testicles into the thigh skin, applied for the reconstruction of penoscrotal defects after surgical debridement due to Fournier’s gangrene, in the light of the literature. A total of 110 patients treated for Fournier’s gangrene at Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Urology, Urology Clinic between 2009 and 2021 were evaluated retrospectively. Among these, 82 patients treated with fasciocutaneous flap and embedding of the testicles into the thigh skin for the reconstruction of penoscrotal defects were included in the study. For these two wound closure methods, the cases were compared in age, hospital stay after debridement, hospital stay after wound closure, size of the debrided area, and postoperative complication parameters. There was no significant difference between the two groups in terms of age, comorbidity (hypertension, diabetes mellitus, etc.), and hospital stay after debridement. However, the length of hospital stay after wound closure and the size of the debrided area were significantly higher in patients with fasciocutaneous flap compared to the method in which the testis was embedded in the thigh. The fasciocutaneous flap application, which we apply for defects larger than 50% of the scrotum or extending beyond the scrotum, is a method that can be preferred by experienced surgeons for wound closure after Fournier gangrene debridement, considering patient comfort, since it does not create tension and blood supply to the testis is more comfortable. However, it would be more appropriate for the clinician to make a profit-loss calculation due to both the length of the operation and its more complex nature and the prolongation of the hospital stay after wound closure

Keywords:

Fournier's gangrene debridement, fasciocutaneous flap,

PDF

___

1. Fournier JA. Gangrene foudroyante de la verge. MedPract. 1883;4:589-97.
2. Baurienne H. Sur une plaie contuse qui s’est terminee par le sphacele de la scrotum. J Med Chir Pharm. 1764;20:251-6
3. Wilson B. Necrotizing fasciitis. Am Surg. 1952;18:416-31.
4. Bugra D, Bozfakioglu Y, Buyukuncu Y, Bulut T. Gangrène de Fournier. Etude analytique de six cas [Fournier’s gangrene. Analytic study of 6 cases]. J Chir (Paris). 1990;127(2):115-6.5. Joury A, Mahendra A, Alshehri M, Downing A: Extensive necrotizing fasciitis from Fournier’s gangrene. Urol Case Rep. 2019;26:100943. doi: 10.1016/j.eucr.2019.10094.
6. Jones J. Investigation upon nature, causes and treatment of hospital gangrene as it prevailed in the confederate armies 1861-1865. New York, NY: US Sanitary Commission; 1871.
7. Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg. 2000;87(6):718-28. doi: 10.1046/j.1365-2168.2000.01497.x.
8. Pizzorno R, Bonnini F, Donelli R, Stubinskl M. Hyperbaric oxygen therapy in the treatment of Fournier’s disease in 11 male patients. J Urol. 1997;158:837-40. doi: 10.1097/00005392-199709000-00039.
9. Öztürk O, Bircan K, Şahin H, Korkmaz K, İslim F. Fournier gangreni: Skrotum ve perinenin nekrotizan yumuşak doku infeksiyonu (in Turkish). Dicle Tıp Dergisi 1994:21;137-40.
10. Paty R, Smith AD. Gangrene and Fournier’s gangrene. Urol Clin North Am. 1992;19(1):149-62.
11. Aşci R, Sarikaya S, Büyükalpelli R, Yilmaz AF, Yildiz S. Fournier’s gangrene: risk assessment and enzymatic debridement with lyophilized collagenase application. Eur Urol. 1998;34(5):411-8. doi: 10.1159/000019775.
12. Rani SA, Hoon R, Najafi RR, Khosrovi B, Wang L, Debabov D. The in vitro antimicrobial activity of wound and skin cleansers at nontoxic concentrations. Adv Skin Wound Care. 2014;27:65–9. doi: 10.1097/01.ASW.0000443255.73875.a3.
13. Safioleas M, Stamatakos M, Mouzopoulos G, Diab A, Kontzoglou K, Papachristodoulou A. Fournier’s gangrene: Exists and it is still lethal. Int Urol Nephrol. 2006;38:653-7. doi: 10.1007/s11255-005-2946-6.
14. Morua AG, Lopez JA, Garcia JD, Montelongo RM, Guerra LS. Fournier’s gangrene: Our experience in 5 years, bibliographic review and assessment of the Fournier’s gangrene severity index. Arch Esp Urol. 2009;62(7):532-40.
15. Gorbach SL. Bartlett JG, Blacklow NR. Infectious diseases. Lippincott Williams & Wilkins. 2004.
16. Goh T, Goh LG, Ang CH, Wong CH. Early diagnosis of necrotizing fasciitis. Br J Surg. 2014;101(1):e119-25. doi: 10.1002/bjs.9371.
17. Sato R, Tomioka T, Orii R, Yamada Y. Anesthetic managements of four patients with Fournier’s syndrome Masui. 2008;57(3):355-7.
18. Çalışkan S, Özsoy E, Sungur M, Gözdaş HT. Fournier’s gangrene: Review of 36 cases. Ulus Travma Acil Cerrahi Derg, 2019;25(5):479-83.
19. Yan Z, Gang X, Xie X, Gao Y, Li Z, Wang G. A case report and literature review: Identification of a novel AIRE gene mutation associated with Autoimmune Polyendocrine Syndrome Type 1 in East Asians. Medicine (Baltimore). 2020;99(18):e20000. doi: 10.1097/MD.0000000000020000.
20. Singh A, Ahmed K, Aydin A, Khan MS, Dasgupta P. Fournier’s gangrene. A clinical review. Arch Ital Urol Androl. 20165;88(3):157-64. doi: 10.4081/aiua.2016.3.157.
21. Insua-Pereira I, Ferreira PC, Teixeira S, Barreiro D, Silva Á: Fournier’s gangrene: A review of reconstructive options. Cent European J Urol. 2020;73:74-9. doi: 10.5173/ceju.2020.0060.
22. Ballard DH, Mazaheri P, Raptis CA, Lubner MG, Menias CO, Pickhardt PJ, et al. Fournier gangrene in men and women: Appearance on CT, ultrasound, and MRI and what the surgeon wants to know. Can Assoc Radiol J. 2020;71:30-9. doi: 10.1177/0846537119888396.
23. Koitabashi T, Umemura N, Takino Y. A case of Fournier’s gangrene contraindicating spinal anesthesia. Anesthesiology. 2000;92(1):289-90. doi: 10.1097/00000542-200001000-00059.
24. Tucci G, Amabile D, Cadeddu F, Milito G. Fournier’s gangrene wound therapy: our experience using VAC device. Langenbecks Arch Surg. 2009;394(4):759-60. doi: 10.1007/s00423-009-0486-8.
25. Aridogan IA, Izol V, Abat D, Karsli O, Bayazit Y, Satar N. Epidemiological characteristics of Fournier’s gangrene: A report of 71 patients. Urol Int. 2012;89(4):457-61. doi: 10.1159/000342407.
26. Martinschek A, Evers B, Lampl L, Gerngroß H, Schmidt R, Sparwasser C. Prognostic aspects, survival rate, and predisposing risk factors in patients with Fournier’s gangrene and necrotizing soft tissue infections: Evaluation of clinical outcome of 55 patients. Urol Int. 2012;89(2):173-9. doi: 10.1159/000339161.
27. Hejase MJ, Simonin JE, Bihrle R, Coogan CL. Genital Fournier’s gangrene: Experience with 38 patients. Urology. 1996;47(5):734-9. doi: 10.1016/s0090-4295(96)80017-3.
28. Benizri E, Fabiani P, Migliori G, Chevallier D, Peyrottes A, Raucoules M, et al. Gangrene of the perineum. Urology. 1996;47(6):935-9. doi: 10.1016/S0090-4295(96)00058-1.
29. Atakan IH, Kaplan M, Kaya E, Aktoz T, Inci O. A life-threatening infection: Fournier’s gangrene. Int Urol Nephrol. 2002;34(3):387-92. doi: 10.1023/a:1024427418743.
30. Horta R, Cerqueira M, Marques M, Ferreira P, Reis J, Amarante J. Gangrena de Fournier: De urgencia urológica hasta el departamento de cirugía plástica [Fournier’s gangrene: From urological emergency to plastic surgery]. Actas Urol Esp. 2009;33(8):925-9. doi: 10.1016/s0210-4806(09)72884-0.
31. Iavazzo C, Kalmantis K, Anastasiadou V, Mantzaris G, Koumpis V, Ntziora F. Fournier’s gangrene in a patient after third-degree burns: A case report. J Med Case Rep. 2009;26;3:7264. doi: 10.1186/1752-1947-3-7264.
32. 30. Tiwari IN, Seth HP, Mehdiratta KS. Reconstruction of the scrotum by thigh flaps. Plast Reconstr Surg. 1980;66(4):605–7. doi: 10.1097/00006534-198010000-00019.
33. Culp DA, Huffman WC. Temperature determination in the thigh with regard to burying the traumatically exposed testis. J Urol. 1956;76(4):436–438. doi: 10.1016/S0022-5347(17)66718-1.
34. Karian LS, Chung SY, Lee ES. Reconstruction of Defects After Fournier Gangrene: A Systematic Review. Eplasty. 2015;15:e18.
35. Atakan IH, Kaplan M, Kaya E, Aktoz T, Inci O. A life-threatening infection: Fournier’s gangrene. Int Urol Nephrol. 2002;34(3):387-92. doi: 10.1023/a:1024427418743.
36. Watanabe S, Kimura F, Kyan A, Suzuki Nakajima F, Hayakawa M, Nakamura H. [Clinical study on Fournier’s gangrene--value of “through and through drainage”]. Nihon Hinyokika Gakkai Zasshi. 1995;86(6):1137-41. doi: 10.5980/jpnjurol1989.86.1137.
37. Malangoni MA. Necrotizing soft tissue infections: are we making any progress? Surg Infect (Larchmt). 2001;2(2):145-50. doi: 10.1089/109629601750469465.

Başlangıç: 2017
Yayıncı: Holistence Publications

Arşiv

Sayıdaki Diğer Makaleler

The evaluation level of acute trauma pathologies by the emergency medicine physician assistant in abdominal computed tomography images of the trauma patients

Mehmet SOYUGÜZEL, Ayşe ERTEKİN, Esra ÖZGÜL

Comparison of two different surgical techniques in the treatment of Fournier’s Gangrene

Hasan Anıl KURT, Emre Onur GÜVEN

Thoracic computed tomography measures have predictive value in the diagnosis of chronic obstructive pulmonary disease

Mustafa TOSUN, Edhem ÜNVER, Ali KÜPELİ, Erdal KARAVAŞ, Sonay AYDIN

An evaluation of patients who present to the emergency department with dizziness

Oya AKPINAR ORUÇ, Neşe Nur USER

First responders’ innovative methodology and curriculum definition for advanced virtual reality training

Zeynep SOFUOĞLU, Débora Pérez ROBLES, Eric DİDDEREN, Federico Rodrigo CARJAVAL, Turhan SOFUOĞLU, Aysel BAŞER, Jóhanna Noraly VEENEKLAAS

Investigation of the protective effect of vitamin K1 on the heart in streptozotocin induced type 1 diabetes model

Abdulkadir BİLİR, Esra ASLAN