Yanagi Masato, Nishimura Taiji, Kondo Yukihiro, Yamazaki Keiichi, Sakai Shigeki, Ishii Naohiro, Kojo Ken, Hosoda Kei
Department of Urology, Ohtawara Red Cross Hospital, Ohtawara, Japan.
Nihon Hinyokika Gakkai Zasshi. 2011 Jul;102(4):649-54. doi: 10.5980/jpnjurol.102.649.
We encountered a case of Fournier's gangrene complicated with vesicorectocutaneous fistula that was treated with a pedicled rectus abdominis muscle flap (pedicled RA m-c flap). A 75-year-old man was admitted with consciousness disorder and swelling of the scrotum. The patient had noticed swelling of the scrotum 4 days before admission, but he had ignored this condition. The scrotum and the penis appeared necrotic. On the basis of clinical and radiological findings, we diagnosed this condition as Fournier's gangrene. Surgical debridement was performed in conjunction with the use of broad-spectrum antibiotics. After the patient's general condition was improved, the broad defect in the perineal tissue was covered with a pedicled rectus abdominis muscle flap. The flap was successful. In Japan, this is the first case of Fournier's gangrene complicated with vesicorectocutaneous fistula that was treated with a pedicled RA m-c flap. In order to determine whether plastic surgery after debridement shortens the duration of hospitalization, we reviewed the cases of 120 patients with Fournier's gangrene in Japan. We conclude that plastic surgery after debridement does not shorten the duration of hospitalization, however, this procedures is very useful to deep and broad defects by Fournier's gangrene.
我们遇到一例福尼尔坏疽合并膀胱直肠皮肤瘘的病例，采用带蒂腹直肌肌皮瓣（带蒂RA m - c瓣）进行治疗。一名75岁男性因意识障碍和阴囊肿胀入院。患者在入院前4天就注意到阴囊肿胀，但他忽视了这种情况。阴囊和阴茎出现坏死。根据临床和影像学检查结果，我们将此病例诊断为福尼尔坏疽。在使用广谱抗生素的同时进行了手术清创。患者一般情况改善后，会阴部组织的大面积缺损用带蒂腹直肌肌皮瓣覆盖。该皮瓣手术成功。在日本，这是首例采用带蒂RA m - c瓣治疗的福尼尔坏疽合并膀胱直肠皮肤瘘的病例。为了确定清创术后的整形手术是否能缩短住院时间，我们回顾了日本120例福尼尔坏疽患者的病例。我们得出结论，清创术后的整形手术并不能缩短住院时间，然而，该手术对于福尼尔坏疽造成的深部和大面积缺损非常有用。
