El-Sabbagh Ahmed Hassan
Plastic Surgery Center, Faculty of Medicine, Mansoura University, Egypt.
GMS Interdiscip Plast Reconstr Surg DGPW. 2018 Jan 15;7:Doc01. doi: 10.3205/iprs000121. eCollection 2018.
Fournier's gangrene is a necrotizing fasciitis caused by mixed aerobic and anaerobic bacteria and results in loss of skin and subcutaneous tissue in the perineal area. Coverage of testis varies from closure of the defect primarily, burying inside the thigh, using the remnants of the scrotum for tissue expansion and coverage by flaps. In this manuscript, scrotal advancement flaps and pudendal thigh flaps were used for coverage of the testis unilaterally or bilaterally according to the size of the defect following Fournier gangrene. From June 2015 to March 2017, twelve cases were admitted to our department. The patients' ages ranged from 37-59 years and they all had suffered from Fournier's gangrene in the perineal area. Of the twelve cases, two cases showed penile involvement. A skin graft was used for coverage of the penile shaft with excellent take. Four cases were closed primarily. This was applied to cases where loss of skin was less than 50%. The rest of the cases were reconstructed by pudendal thigh flap. The reconstructed cases were covered by bilateral pudendal thigh flap (4 cases) and unilateral pudendal thigh flap (4 cases). The follow-up extended up to 16 months. Scrotal advancement flap was suitable for small and medium size defects due to the elasticity of the scrotal skin. Pudendal thigh flap was efficient for the reconstruction of large defects of the scrotum.
福尼尔坏疽是一种由需氧菌和厌氧菌混合感染引起的坏死性筋膜炎，可导致会阴区皮肤和皮下组织缺失。睾丸的覆盖方式多种多样，主要包括直接闭合缺损、埋入大腿内侧、利用阴囊残余组织进行组织扩张以及皮瓣覆盖等。在本论文中，根据福尼尔坏疽后缺损的大小，单侧或双侧采用阴囊推进皮瓣和阴部大腿皮瓣覆盖睾丸。2015年6月至2017年3月，我科共收治12例患者。患者年龄在37至59岁之间，均患有会阴区福尼尔坏疽。12例患者中，2例阴茎受累。采用皮肤移植覆盖阴茎体，移植效果良好。4例患者直接闭合伤口，适用于皮肤缺失小于50%的病例。其余病例采用阴部大腿皮瓣进行重建。重建病例中，双侧阴部大腿皮瓣覆盖4例，单侧阴部大腿皮瓣覆盖4例。随访时间长达16个月。由于阴囊皮肤的弹性，阴囊推进皮瓣适用于中小尺寸的缺损。阴部大腿皮瓣对阴囊大缺损的重建效果良好。
