What are the options for reconstruction in Fournier gangrene?

Updated: Jun 03, 2021
  • Author: Vernon M Pais, Jr, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Once the infection is eradicated, healthy granulation tissue develops; this signifies the time to proceed to reconstruction.

Options for reconstruction include the following:

  • Primary closure of the skin, if possible
  • Local skin flap coverage
  • Split-thickness skin grafts
  • Muscular flaps, which are used to fill a cavity (eg, ischiorectal space)

On the basis of a systematic review of 16 studies, Karian et al concluded that, "most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. There is no conclusive evidence to support flap coverage of exposed testes rather than skin graft." However, these authors recommended skin grafting or flap reconstruction for defects larger than 50% of the scrotum or extending beyond the scrotum; for defects confined involving less than 50% of the scrotum that cannot be closed primarily without tension, they recommended reconstruction with a scrotal advancement flap or healing by secondary intention. [70]

Konofaos and Hickerson have reported a two-step technique for treating scrotal defects with total skin loss involving exposed testes. The first step consists of primary closure with a wrap-around skin grafting. The second step comprises reapproximating the testes and shaping the neoscrotum to optimize cosmesis. [71]


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