Complete Preservation Of Scrotal Skin In A Case Of Fournier's Gangrene Involving The Inguinoscrotal And Perineal Region

ACC 

Fournier's gangrene is defined as a polymicrobial necrotizing fasciitis that involves the inguinal, perineal, testis, scrotal and perianal regions. The infection spreads in the superficial and deep fascia planes. Often the scrotal skin is involved and is subject to partial or complete surgical debridement. This results in an exposed testis requiring temporary burying and definitive unsightly skin grafting or flap reconstruction. We present the successful management of Fournier's gangrene originating from a left epididymo-orchitis in a 35 year old man. He developed excruciating pain over the left scrotum and clinically the scrotal skin was red and inflamed. CT scan showed a large 15cm x 15cm x 12cm area of cellulitis and abscess collection in the left inguinoscrotal region extending into the perineum. Debridement was done on day 4 of admission. A decision was made to preserve the scrotal skin. An incision was made from the left lateral inguinal region and extended down to the left perianal region. 100 mls of frank pus was drained. A very thin layer of scrotal skin was preserved while the underlying fascia and muscles were debrided from the underside. A total of four surgical debridements were performed and the wound was closed in stages starting inferiorly while the superiorly located wounds were dressed with negative pressure wound therapy (NPWT). As early as the second debridement, the testis was placed back into the scrotum with a drainage tube. Apart from a small wound breakdown at the inguinal region requiring secondary suturing, all other sutures remained intact.The patient had no external defect or scar apart from a fine line running from the left inguinal region down to the left perineum. The scrotal skin survived 100%. The robust circulation of the scrotum and its excellent wound healing properties gives an opportunity to preserve the scrotal skin when there is no obvious necrosis. This is useful in avoiding complications such as painful testes retraction and the need for scrotal reconstruction using skin grafts or flaps.

Reconstructive

Plastic Surgery 2023