2017, Number 4
Rev Mex Urol 2017; 77 (4)
Preciado-Estrella DA, Calvo-Vázquez I, Cortés-Raygoza PA, Hernández-Méndez EA, Ortega-González M, López-Maguey R
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ABSTRACTBackground: Fournier’s gangrene is an acute and fulminating inflammatory-infectious process that produces necrosis of the skin and the fasciae of the scrotum, penis, and perineum. The disease can be fatal in up to 45% of the cases, and it requires multidisciplinary management.
Clinical case: A 62-year-old man, with no alterations relevant to his present condition, had undergone surgery due to urethral stricture one week prior to hospital admission. Physical examination revealed genital and perineal edema and erythema that extended to both inguinal regions and the hypogastrium, sparing the anus. Neutrophilia with 32,000 leukocytes and bandemia with a Fournier’s Gangrene Severity Index of 10 points were reported in the laboratory work-up. Aggressive debridement of the genitals and perineum was performed, finding necrosis and purulent exudate that extended to and infiltrated the fascia of Camper, fascia of Scarpa, and the anterior aponeurosis up to 10 cm above the pubic symphysis. The debridement was continued, and from the third lavage, was managed through the vacuum-assisted closure system. Five more lavages were completed in the operating room and the devices were changed. The patient progressed adequately and was released after 24 days of treatment.
Conclusion: The use of vacuum-assisted closure devices is an effective, useful, and reproducible method that guarantees good functional and cosmetic results and reduces hospital stay and complications.