medigraphic.com
Organo Oficial de la Sociedad Mexicana de Urología

2020, Number 6

<< Back Next >>

Rev Mex Urol 2020; 80 (6)

Reconstruction of sequelae due to Fournier’s gangrene: report of two cases

Bravo-Gálvez VM, González-Villegas HO

Language: Spanish
References: 12
Page: 1-12
PDF size: 466.04 Kb.


ABSTRACT

Clinical case description: Two men, 47 and 39 years of age, with a history of type 2 diabetes mellitus, developed Fournier’s gangrene. They underwent emergency debridement, requiring 2 or more surgical toilets, and received antibiotic therapy. One patient underwent vacuum-assisted closure. Once the patients recovered, reconstructive surgery with advancement flaps and full-thickness autologous skin grafts taken from the thigh were carried out, respectively.
Relevance: Fournier’s gangrene is an infection that has a high mortality rate. It involves the soft tissues of the perineal and genital regions of immunocompromised patients, requiring aggressive surgical management that leaves important anatomic and functional sequelae. When our patients recovered, there was little evidence of the monitoring and treatment of Fournier’s gangrene sequelae.
Clinical implications: The goal of reconstructive therapy is the reincorporation of the patient into his everyday life, attempting to maintain the anatomy as normal and functional as possible. There are still no guidelines on the best reconstruction method for Fournier’s gangrene sequelae but at present the use of grafts are considered the best measure.
Conclusion: The use of full-thickness autologous skin grafts was beneficial in our patients. However, a review of the literature should be carried out to standardize the use of grafts and reconstructive techniques, according to the sequelae.


REFERENCES

  1. Ioannidis O, Kitsikosta L, Tatsis D, Skandalos I, Cheva A, Gkioti A, et al. Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis. Front Surg. 2017;4:36. doi: https://doi.org/10.3389/fsurg.2017.00036

  2. Morua AG, Lopez JAA, Garcia JDG, Montelongo RM, Guerra LSG. Fournier’s gangrene: our experience in 5 years, bibliographic review and assessment of the Fournier’s gangrene severity index. Arch Esp Urol. 2009 Sep;62(7):532–40.

  3. Corcoran AT, Smaldone MC, Gibbons EP, Walsh TJ, Davies BJ. Validation of the Fournier’s gangrene severity index in a large contemporary series. J Urol. 2008 Sep;180(3):944–8. doi: https://doi.org/10.1016/j.juro.2008.05.021

  4. Erol B, Tuncel A, Hanci V, Tokgoz H, Yildiz A, Akduman B, et al. Fournier’s gangrene: overview of prognostic factors and definition of new prognostic parameter. Urology. 2010 May;75(5):1193–8. doi: https://doi. org/10.1016/j.urology.2009.08.090

  5. Nisbet AA, Thompson IM. Impact of diabetes mellitus on the presentation and outcomes of Fournier’s gangrene. Urology. 2002 Nov;60(5):775–9. doi: https://doi.org/10.1016/ s0090-4295(02)01951-9

  6. Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, et al. Fournier’s gangrene: risk factors and strategies for management. World J Surg. 2006 Sep;30(9):1750–4. doi: https://doi.org/10.1007/s00268-005-0777-3

  7. Czymek R, Schmidt A, Eckmann C, Bouchard R, Wulff B, Laubert T, et al. Fournier’s gangrene: vacuum-assisted closure versus conventional dressings. Am J Surg. 2009 Feb;197(2):168–76. doi: https://doi.org/10.1016/j.amjsurg.2008.07.053

  8. Yu P, Sanger JR, Matloub HS, Gosain A, Larson D. Anterolateral thigh fasciocutaneous island flaps in perineoscrotal reconstruction. Plast Reconstr Surg. 2002 Feb;109(2):610– 6; discussion 617-618. doi: https://doi. org/10.1097/00006534-200202000-00030

  9. Kayikçioğlu A. A new technique in scrotal reconstruction: short gracilis flap. Urology. 2003 Jun;61(6):1254–6. doi: https://doi. org/10.1016/s0090-4295(03)00158-4

  10. Ferreira PC, Reis JC, Amarante JM, Silva AC, Pinho CJ, Oliveira IC, et al. Fournier’s gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg. 2007 Jan;119(1):175–84. doi: https://doi. org/10.1097/01.prs.0000244925.80290.57

  11. Karaçal N, Livaoglu M, Kutlu N, Arvas L. Scrotum reconstruction with neurovascular pedicled pudendal thigh flaps. Urology. 2007 Jul;70(1):170–2. doi: https://doi.org/10.1016/j. urology.2007.03.049

  12. Carvalho JP, Hazan A, Cavalcanti AG, Favorito LA. Relation between the area affected by Fournier’s gangrene and the type of reconstructive surgery used. A study with 80 patients. Int Braz J Urol. 2007 Aug;33(4):510–4. doi: https://doi. org/10.1590/s1677-55382007000400008




2020     |     www.medigraphic.com