Scrotal Defects Reconstruction after Fournier's Gangrene

Background and aim: Fournier's gangrene is necrotizing fasciitis of the perineum and external genitalia. It involves the perianal area and scrotum. Adequate wound debridement, a broad-spectrum antibiotic, and fluid replacement therapy are all part of the treatment plan. After clinical stabilization, reconstruction can be planned secondarily.
Materials and methods: Fifteen patients who underwent reconstruction after Fournier's gangrene in 2017 July to 2019 June at Burn and Plastic Surgery Department, Rajshahi Medical College Hospital, were analyzed retrospectively. All the patients were referred from General Surgery wards after completing initial management. Informed consent was obtained from all patients.
Results: The most commonly used reconstructive methods were Scrotal advancement flaps, Pudendal thigh flap, medial thigh flap, Superomedial thigh flap. Penile wound coverage by split-thickness skin grafting was done in 03 cases. After reconstruction, the mean hospital stay was 5 days. 03 patients developed marginal flap necrosis (<5 mm), 5-10 mm tip necrosis in 02 cases and necrosis at three-point stitch area were in 03 cases. All the marginal necrosis and dehiscence areas healed conservatively. Due to negative suction drains, there were no Hematoma or Seroma complications.
Conclusion: There is no perfect method for all patients. Instead, the ideal methodology is determined by the patient's age, expectations, and overall condition, defect characteristics, and the surgeon's experience.