Sánchez DDM, Ortiz RJL, Luévano GE

Language: Spanish
References: 10
Page: 38-43
PDF size: 271.88 Kb.

ABSTRACT

Fournier’s gangrene is an infectious necrotizing fasciitis characterized by endarteritis obliterative of the subcutaneous arteries, which mainly affect the external genitalia, principally in males over 50 years old and/or with some immunosuppression. Early diagnosis is imperative, since the rapid progression of gangrene can lead to multiple organ failure and death. The diagnosis is clinical and the means of treatment include rapid and extensive surgical debridement of the necrotic tissue, hemodynamic support with water resuscitation and antibiotic therapy. In cases of severe perineal involvement, fecal diversion has been used. After extensive debridement, many patients suffer significant skin and soft tissue defects, which pose the need to reconstruct to obtain satisfactory functional and aesthetic results. We present the case of an 18-year-old man with acute lymphoblastic leukemia, who progressed from a perineal abscess to a Fournier gangrene evolving into necrosis, undergoing surgical debridement and placement of a vacuum-assisted closure system. Once the septic process was controlled, the defect was reconstructed with a forward fasciocutaneous flap, the left testicle was handled in a subcutaneous bag in the upper region of the thigh, and partial thickness grafts taken from the upper thighs, used in the penis, left testicle, left inguinal region and a cutaway flap of the gluteus maximus in island with «V» closure to cover the lumbosacral region, obtaining satisfactory results.

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