Management of scrotal soft tissue defects in patients with Fournier’s gangrene

Abstract

Introduction: Fournier’s gangrene is a necrotizing fasciitis caused by mixed aerobic and anaerobic bacteria resulting in loss of skin and subcutaneous tissue in the perineal area. Various techniques have been described for the reconstruction which we intend to study and thereby propose a reconstructive algorithm. Methods: From June 2018 to October 2019, twenty patients aged between 35–80 years with Fournier’s gangrene were posted for reconstruction of scrotal soft tissue defect. Depending on the size of the defect and amount of tissue loss, patients underwent various procedures for reconstruction which included primary closure, advancement flaps and fasciocutaneous flaps. Patients were followed up post-operatively for 3 months. Results: All patients posted for reconstruction had a single stage, stable, and well-vascularized soft tissue coverage in scrotal defect cases without significant major complication. Seven patients underwent secondary closure, six patients underwent advancement flaps, five patients underwent medial thigh flaps with two patients undergoing SSG in addition to advancement flap. Patients were assessed based on restoring anatomy, cosmetic function and psychological satisfaction. There was good functional as well as acceptable cosmetic outcome in the patients without any significant complications. Conclusion: Most reconstructive techniques provide reliable coverage. In defects confined to lesser than 50% of scrotum, local advancement flap reconstruction is the ideal tension free closure. Medial thigh flap is recommended for defects larger than 50% of the scrotum.