Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
J Plast Reconstr Aesthet Surg. 2011 Apr;64(4):528-34. doi: 10.1016/j.bjps.2010.07.018. Epub 2010 Aug 24.
Fournier's gangrene is an acute and potentially lethal necrotising fasciitis that involves the scrotum and perineum. This disease can result in the loss of skin and soft tissue. To repair the scrotal and perineal defects remains a surgical challenge.
Between January 2000 and December 2008, 50 patients were admitted to our hospital with a diagnosis of Fournier's gangrene. We retrospectively reviewed 31 of the 44 surviving patients, who needed reconstructive procedures for coverage of scrotal and perineal soft-tissue defects. The choice of reconstructive procedure was based on the size, location, severity of the defects and the availability of local tissue. The patients' age, predisposing factors, defect size and location, reconstructive procedures and outcomes were reviewed.
The mean age of the patients was 53.6 years (range, 20-84 years). The average size of the skin defect was 86 cm(2). A total of 12 patients were treated by scrotal advancement flap coverage, nine by split-thickness skin graft, five by pudendal thigh flap, two by gracilis myocutaneous flap, one by gracilis muscle flap plus split-thickness skin graft and three by pedicle anterolateral thigh flap. The overall surgical complication rate was 16%.
Early debridement and wound coverage in Fournier's gangrene are mandatory to allow patients to return to normal life. We set up a valuable reconstructive algorithm based on the characteristics of the defects and our 9 years of experience, which adds to the versatility of the armamentarium of the reconstructive surgeon.
Fournier 坏疽是一种累及阴囊和会阴的急性、潜在致命性坏死性筋膜炎。这种疾病可导致皮肤和软组织的丧失。修复阴囊和会阴的缺陷仍然是一个手术挑战。
2000 年 1 月至 2008 年 12 月，我院收治了 50 例 Fournier 坏疽患者。我们回顾性分析了 44 例存活患者中的 31 例，这些患者需要进行重建手术以覆盖阴囊和会阴的软组织缺陷。重建手术的选择取决于缺陷的大小、位置、严重程度以及局部组织的可用性。回顾了患者的年龄、易患因素、缺陷的大小和位置、重建手术和结果。
患者的平均年龄为 53.6 岁（范围，20-84 岁）。皮肤缺损的平均大小为 86cm²。共有 12 例患者采用阴囊推进皮瓣覆盖治疗，9 例采用薄层皮片移植，5 例采用阴部股前皮瓣，2 例采用股薄肌肌皮瓣，1 例采用股薄肌肌皮瓣加薄层皮片移植，3 例采用带蒂股前外侧皮瓣。总的手术并发症发生率为 16%。
早期清创和 Fournier 坏疽的伤口覆盖是使患者恢复正常生活的必要条件。我们根据缺陷的特点和 9 年的经验制定了一个有价值的重建算法，这增加了重建外科医生的手术工具的多功能性。
