Genital Reconstruction following Fournier's Gangrene

Panos Michael; Bryony Peiris; David Ralph; Mark Johnson; Wai Gin Lee

doi:10.1016/j.sxmr.2022.05.002

Genital Reconstruction following Fournier's Gangrene

Sex Med Rev. 2022 Oct;10(4):800-812. doi: 10.1016/j.sxmr.2022.05.002. Epub 2022 Aug 23.

Authors

Panos Michael¹, Bryony Peiris¹, David Ralph², Mark Johnson², Wai Gin Lee³

Affiliations

¹ UCL Medical School, University College London, London, UK.
² St. Peter's Andrology Centre and UCLH, London, UK.
³ St. Peter's Andrology Centre and UCLH, London, UK. Electronic address: waigin.lee@nhs.net.

PMID: 36028436
DOI: 10.1016/j.sxmr.2022.05.002

Abstract

Introduction: Fournier's gangrene is a urological emergency, comprising of type I necrotizing fasciitis resulting in anatomic defects affecting the perineum, perianal region, and external genitalia in both men and women, often requiring reconstruction.

Objectives: The aim of this article is to provide a comprehensive review of the different reconstructive techniques for Fournier's gangrene.

Methods: A literature search was performed on PubMed with the search terms "Fournier"s gangrene" "genital reconstruction" and "Fournier's gangrene phalloplasty." The European Association of Urology's guidelines on Urological infections were also consulted for recommendations.

Results: Reconstructive procedures include primary closure, scrotal advancement flaps, fasciocutaneous flaps, myocutaneous flaps, skin grafts, and phalloplasty. There is insufficient evidence to support that flaps lead to better outcomes than skin grafts, or vice versa, particularly for scrotal defects. Both techniques have been shown to have satisfactory aesthetic results, with good skin color match and natural scrotal contour. With regards to phalloplasty, there is a lack of data specifically relating to Fournier's gangrene, as most articles were addressed toward gender affirmation surgery. Furthermore, there is a lack of guidelines in both the immediate and reconstructive management of Fournier's gangrene. Lastly, the outcomes reported following reconstructive surgery have been objective rather than subjective, meaning that patient satisfaction was rarely recorded.

Conclusion: Further research is required in the field of reconstructive surgery specific to Fournier's gangrene, which should also take into consideration patient demographics and subjective reports regarding cosmesis and sexual function. Michael P, Peiris B, Ralph D, et al. Genital Reconstruction following Fournier's Gangrene. Sex Med Rev 2022;10:800-812.

Keywords: Fournier's gangrene; Phalloplasty; Reconstructive surgery; Skin flaps; Skin grafts.

Publication types

Review

MeSH terms

Female
Fournier Gangrene* / surgery
Humans
Male
Perineum
Scrotum / surgery
Skin Transplantation
Surgical Flaps / surgery