Genital Reconstruction following Fournier's Gangrene

Scrotal reconstruction after Fournier's Gangrene using the superficial circumflex iliac artery perforator (SCIP) propeller flap: A case report

INTRODUCTION

Fournier's gangrene, a rare infectious condition affecting the external genitalia, often requires aggressive medical-surgical interventions, resulting in variable scrotal tissue loss. Despite numerous proposed reconstruction techniques, achieving a consensus on the most effective approach that balances aesthetics and function remains elusive. This case report presents a one-year follow-up on scrotal reconstruction using a pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) propeller flap.

CASE REPORT

A 56-year-old patient with significant scrotal tissue loss due to Fournier's gangrene underwent scrotal reconstruction using a pedicled SCIP propeller flap. Optimal placement was ensured through a subcutaneous tunnel, with a thin thigh skin graft applied to cover the penile skin defect.

DISCUSSION

The SCIP flap is distinguished by its thin and pliable characteristics, rapid harvesting and featuring a discreet donor site. It stands as a compelling alternative to skin grafts, providing advantages in sensory restoration, color congruence, and resilience against tension. Considering the thickness of the reconstruction helps both in recovering testicular function and improving the appearance by restoring the natural contour.

CONCLUSION

The utilization of the pedicled SCIP propeller flap for scrotal tissue loss resulting from Fournier's gangrene has demonstrated both aesthetic and functional success, underscoring its potential as an effective reconstructive option.

Crafting Contours: A Comprehensive Guide to Scrotal Reconstruction

This review delves into reconstructive methods for scrotal defects arising from conditions like Fournier's gangrene, cancer, trauma, or hidradenitis suppurativa. The unique anatomy of the scrotum, vital for thermoregulation and spermatogenic function, necessitates reconstruction with thin and pliable tissue. When the scrotal defect area is less than half the scrotal surface area, scrotal advancement flap can be performed. However, for larger defects, some type of transplantation surgery is required. Various options are explored, including testicular transposition, tissue expanders, split-thickness skin grafts, local flaps, and free flaps, each with merits and demerits based on factors like tissue availability, defect size, and patient specifics. Also, physicians should consider how testicular transposition, despite its simplicity, often yields unsatisfactory outcomes and impairs spermatogenesis. This review underscores the individuality of aesthetic standards for scrotal reconstruction, urging surgeons to tailor techniques to patient needs, health, and defect size. Detailed preoperative counseling is crucial to inform patients about outcomes and limitations. Ongoing research focuses on advancing techniques, not only anatomically but also in enhancing post-reconstruction quality of life, emphasizing the commitment to continuous improvement in scrotal reconstruction.

Progress in Multidisciplinary Treatment of Fournier's Gangrene

Fournier's gangrene (FG) is a life-threatening and special form of necrotizing fasciitis, characterized by occult onset, rapid progress and high mortality, occurring mainly in men over 50 years of age. Risk factors of FG include diabetes, HIV infection, chronic alcoholism and other immunosuppressive state. FG was previously considered as an idiopathic disease, but in fact, three quarters of the infections originated from the skin, urethra and gastrointestinal tract. Initial symptoms of FG are often inconsistent with severity and can progress promptly to fatal infection. Although the treatment measures of FG have been improved in recent years, the mortality does not seem to have decreased significantly and remains at 20% - 30%. The time to identify FG and the waiting period before surgical debridement are directly related to the prognosis. Therefore, in addition to the combination of intensive fluid resuscitation and broad-spectrum antibiotics, treatment of FG should particularly emphasize the importance of early surgical debridement assisted with fecal diversion and skin reconstruction when necessary. This paper is to briefly summarize the progress in the definition, epidemiology, clinical manifestations, diagnosis, treatment and prognosis of Fournier's gangrene in recent years, more importantly, illustrates the importance of multidisciplinary cooperation in the management of FG.