Complex reconstruction after extreme Fournier’s gangrene; a case report

• Published in: Journal of Mind and Medical Sciences Vol. 7; no. 2; pp. 261 - 264
• Main Authors: Dumitrache, Serban, Goman, Leonida A, Dutu, Raluca, Capatina, Raluca, Giuglea, Carmen, Enescu, Dan M
• Format: Journal Article
• Language: English
• Published: The Lutheran University Association, Inc., dba Valparaiso University 01.10.2020; Ion Motofei, Carol Davila University
• Subjects: fournier’s gangrene; Gangrene; Health aspects; Infection; Meropenem; Mortality; plastic surgery; reconstruction; Romania; Romania
• ISSN: 2392-7674; 2392-7674
• DOI: 10.22543/7674.72.P261264

In this article we present a severe case of Fournier's gangrene (FG) that affected a 64-year-old male patient, with no other known comorbidities. FG is a type of necrotizing fasciitis of the perineal and genital regions, that affects mostly males in the 5th-7th decades, with mortality rates that reach 70%. The infection usually advances through the superficial fascial layers of the perineum and abdomen and affects the skin. In our case the infection also affected the spermatic fasciae and advanced in the abdominal and pelvic cavities, abdominal muscles, and surrounding soft tissues. Subsequent debridement left the patient with large soft tissue and muscle defects and an open abdominal cavity that needed reconstruction. We designed two pedicled tensor fascia lata flaps with extra fascia for abdominal support. Healing was marked by a pseudomonas aeruginosa infection that led to skin graft sloughing and marginal wound breakdown, which was treated with antibiotics and local wound care. Eventually the wounds healed, and the patient left the hospital 11 weeks after admittance. The outcome of the case was good considering the initial extent of the infection. The cosmetic shortcomings were not shared by the patient and future scar corrections are planned.