Penile reconstruction after Fournier's gangrene

Abstract

Introduction and objective: The lethal necrotizing fasciitis, Fournier's Gangrene, is initially managed with resuscitation, broad-spectrum antibiotics, and aggressive surgical debridement. While the initial management steps are widely described, the subsequent management of skin loss is sparse. Our objective was to focus on the reconstruction of the penile shaft skin loss after wide surgical debridement. Methods: A single case was documented from presentation, to treatment, and to recovery. The primary focus was the reconstruction of the penile shaft skin. The combined planning and efforts of genitourinary and plastic surgery were used to reconstruct the penile shaft skin using a split thickness skin graft. Results: The penis was tunneled into a viable skin flap of the suprapubic fat pad in response to the wide surgical debridement from the treatment of Fournier's Gangrene. The penis maintained its anatomic function during the healing process. A 12/1000-in. split thickness skin graft from the lateral thigh was chosen to replace the skin deficient. 13 months later, we were able to excise around the preputial collar, un-tunnel the penis and place the skin graft around the penile shaft. A vacuum dressing and foley catheter remained in place for 7 days during an uneventful post-operative course. Ultimately, we found split thickness skin graft successful in this penile reconstruction after Fournier's Gangrene. Conclusion: Complete penile shaft skin loss can be managed acutely with tunneling in the suprapubic fat pad, and can be reconstructed with a split thickness skin graft from the lateral thigh.

Keywords

• Reconstruction
• Fournier gangrene
• Penile tunneling
• Plastic surgery
• Split thickness skin graft