Meyer Ganz Oanna, Gumener Raphaël, Gervaz Pascal, Schwartz Julien, Pittet-Cuénod Brigitte
Division of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.
BMC Surg. 2012 Dec 23;12:26. doi: 10.1186/1471-2482-12-26.
Fournier's gangrene is a bacterial infection characterized by necrotizing fasciitis, skin and soft tissue involvement, and eventually myositis of the perineal region. Aggressive debridement of devitalized tissue and overlying skin is of paramount importance, but often leaves large defects to be reconstructed. The present case reports successful extensive perineal defects coverage following Fournier's gangrene and management of subsequent penile lymphoedema impairing sexual function in a young patient.
Following perianal abscess drainage, a healthy young man presented with scrotal pain. Fournier's gangrene was diagnosed and treated with multiple surgical debridements. Tissue excision extended through the entire perineal area, base of the penile shaft, lower abdominal region, the inner thighs, and gluteal region, corresponding to 12% of the total body surface area. After serial debridements and negative pressure dressings, the defect was covered by two stages of skin grafting. Graft take was 90%. Healing was achieved without hypertrophic or retractile scar. However, chronic penile lymphedema remained and was first treated with compressive garments for 2 years. Upon failure of this conservative approach, we performed a circumcision, but only a "penile lift" allowed a satisfactory esthetical and functional result.
Fournier's gangrene can be complicated by a chronic lymphedema of the penis. Conservative treatment is likely to fail in severe cases and can be treated surgically by "penile lift".
福尼尔坏疽是一种细菌感染，其特征为坏死性筋膜炎、皮肤和软组织受累，最终累及会阴区域的肌肉。对失活组织及覆盖皮肤进行积极清创至关重要，但清创后常留下需要修复的大面积缺损。本文报道了一例年轻患者在福尼尔坏疽后成功广泛覆盖会阴缺损以及后续治疗损害性功能的阴茎淋巴水肿的病例。
一名健康的年轻男性在肛周脓肿引流后出现阴囊疼痛。诊断为福尼尔坏疽并接受了多次手术清创治疗。组织切除范围贯穿整个会阴区域、阴茎根部、下腹部、大腿内侧和臀区，占体表面积的12%。经过系列清创和负压敷料处理后，分两期进行皮肤移植覆盖缺损。移植成功率为90%。愈合良好，无肥厚性或挛缩性瘢痕。然而，慢性阴茎淋巴水肿仍然存在，最初使用压迫性衣物治疗了2年。这种保守方法失败后，我们进行了包皮环切术，但只有“阴茎上提术”取得了令人满意的美学和功能效果。
福尼尔坏疽可能并发阴茎慢性淋巴水肿。严重病例保守治疗可能失败，可通过“阴茎上提术”进行手术治疗。
