Outcomes in Fournier's Gangrene Using Skin and Soft Tissue Sparing Flap Preservation Surgery for Wound Closure

An Alternative Approach to Wide Radical Debridement

Travis L. Perry, MD; Lindsay M. Kranker, MD; Erin E. Mobley, PA; Eileen E. Curry, MD; R. Michael Johnson, MD, MPH

Disclosures

Wounds. 2018;30(10):290-299. 

In This Article

Conclusions

Understanding the somatic clues of skin and soft tissue viability is imperative to optimizing clinical and surgical outcomes using spared skin and soft tissue in wound closure of the NSTI FG. This series of 17 consecutive patients with FG who safely achieved large skin and soft tissue flap preservation were treated using a triad of (1) skin and soft tissue sparing debridement, (2) NPWT with antibiotic irrigation, and (3) serial DPC (eFigure 18). This technique has shown success and reproducibility over a 10-year time period at the authors' institution as an alternative approach to traditional NSTI treatments, because complete infection control is uncompromised while safely sparing skin and soft tissue for future reconstruction in FG. This allows the reconstruction of preserved skin and soft tissue flaps as a potential and viable adjunct to perioperative wound management in patients with FG. This skin sparing and flap preservation approach yielded acceptable outcomes while avoiding the long-standing dilemma of how to reconstruct such complex NSTI wounds.

eFigure 18.

Case 17: Primary (A) exploratory incision (black arrow) with counter (A, B) scrotal exploratory incisions (white arrows); (C) staged delayed primary closure of preserved skin and soft tissue flaps; and (D) outpatient follow-up at 44 days showing well-healed original and counter exploratory incisions (white arrows).

In all cases, there was no need for orchiectomies or testicular translocation and rarely a need for skin grafting or colostomy. Skin and soft tissue preservation also obviated the need for management of common surgical complications such as flap loss, skin graft scar contractures, or testicular viability after thigh pouch placement. Reduced LOS, faster healing times, and good cosmesis were achieved. Early meticulous surgical exploration and debridement may minimize the total number of surgeries and hospital LOS. Continued prospective data should be collected on this approach for patients with FG to confirm these promising outcomes.

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