Display options
Cite
Karian LS, Chung SY, Lee ES. Reconstruction of Defects After Fournier Gangrene: A Systematic Review. Eplasty. 2015;15:e18
Karian, L. S., Chung, S. Y., & Lee, E. S. (2015). Reconstruction of Defects After Fournier Gangrene: A Systematic Review. Eplasty, 15e18.
Karian, Laurel S, et al. "Reconstruction of Defects After Fournier Gangrene: A Systematic Review." Eplasty vol. 15 (2015): e18.
Karian LS, Chung SY, Lee ES. Reconstruction of Defects After Fournier Gangrene: A Systematic Review. Eplasty. 2015 May 26;15:e18. eCollection 2015. PMID: 26171090; PMCID: PMC4447098.
Copy Download .nbib Format: NLM
Share it on

Eplasty. 2015 May 26;15:e18. eCollection 2015.

Reconstruction of Defects After Fournier Gangrene: A Systematic Review.

Eplasty

Laurel S Karian, Stella Y Chung, Edward S Lee

Affiliations

  1. Division of Plastic Surgery, Rutgers-New Jersey Medical School, Newark.

PMID: 26171090 PMCID: PMC4447098

Abstract

BACKGROUND: Reconstruction of scrotal defects after Fournier gangrene is often achieved with skin grafts or flaps, but there is no general consensus on the best method of reconstruction or how to approach the exposed testicle. We systematically reviewed the literature addressing methods of reconstruction of Fournier defects after debridement.

METHODS: PubMed and Cochrane databases were searched from 1950 to 2013. Inclusion criteria were reconstruction for Fournier defects, patients 18 to 90 years old, and reconstructive complication rates reported as whole numbers or percentages. Exclusion criteria were studies focused on methods of debridement or other phases of care rather than reconstruction, studies with fewer than 5 male patients with Fournier defects, literature reviews, and articles not in English.

RESULTS: The initial search yielded 982 studies, which was refined to 16 studies with a total pool of 425 patients. There were 25 (5.9%) patients with defects that healed by secondary intention, 44 (10.4%) with delayed primary closure, 36 (8.5%) with implantation of the testicle in a medial thigh pocket, 6 (1.4%) with loose wound approximation, 96 (22.6%) with skin grafts, 68 (16.0%) with scrotal advancement flaps, 128 (30.1%) with flaps, and 22 (5.2%) with flaps or skin grafts in combination with tissue adhesives. Four outcomes were evaluated: number of patients, defect size, method of reconstruction, and wound-healing complications.

CONCLUSIONS: Most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. There is no conclusive evidence to support flap coverage of exposed testes rather than skin graft. A reconstructive algorithm is proposed. Skin grafting or flap reconstruction is recommended for defects larger than 50% of the scrotum or extending beyond the scrotum, whereas scrotal advancement flap reconstruction or healing by secondary intention is best for defects confined to less than 50% of the scrotum that cannot be closed primarily without tension.

Keywords: Fournier gangrene; scrotal advancement flap; scrotal and perineal defects; skin graft; systematic review

References

  1. Plast Reconstr Surg. 2002 Feb;109(2):610-6; discussion 617-8 - PubMed
  2. N Z Med J. 2008 Jun 06;121(1275):46-56 - PubMed
  3. Ann Plast Surg. 1992 Dec;29(6):482-90 - PubMed
  4. Ulus Travma Acil Cerrahi Derg. 2013 May;19(3):215-8 - PubMed
  5. Zhonghua Zheng Xing Wai Ke Za Zhi. 2004 May;20(3):203-5 - PubMed
  6. J Plast Reconstr Aesthet Surg. 2011 Apr;64(4):528-34 - PubMed
  7. J Plast Reconstr Aesthet Surg. 2011 Jul;64(7):944-8 - PubMed
  8. Am Surg. 2002 Aug;68(8):709-13 - PubMed
  9. J Urol. 1956 Oct;76(4):436-8 - PubMed
  10. Ann Plast Surg. 2003 Aug;51(2):155-60 - PubMed
  11. Can Urol Assoc J. 2013 Jul-Aug;7(7-8):E481-5 - PubMed
  12. Burns. 2003 Dec;29(8):857-62 - PubMed
  13. Int Braz J Urol. 2007 Jul-Aug;33(4):510-4 - PubMed
  14. Plast Reconstr Surg. 2004 Jan;113(1):126-32; discussion 133-5 - PubMed
  15. Plast Reconstr Surg. 2007 Jan;119(1):175-84 - PubMed
  16. Urology. 2010 May;75(5):1193-8 - PubMed
  17. Urology. 2007 Jul;70(1):170-2 - PubMed
  18. Afr J Med Med Sci. 2000 Sep-Dec;29(3-4):323-4 - PubMed
  19. Plast Reconstr Surg. 1997 May;99(6):1642-52; discussion 1653-5 - PubMed
  20. Plast Reconstr Surg (1946). 1957 Jun;19(6):509-13 - PubMed
  21. Ann Plast Surg. 2002 Apr;48(4):370-5 - PubMed
  22. Ann Plast Surg. 2011 Nov;67(5):526-30 - PubMed
  23. Br J Plast Surg. 1984 Jul;37(3):354-7 - PubMed
  24. Trop Geogr Med. 1985 Dec;37(4):337-42 - PubMed
  25. Urology. 2013 Aug;82(2):461-5 - PubMed
  26. Urology. 2006 Apr;67(4):688-91; discussion 691-2 - PubMed
  27. Ann Urol (Paris). 1995;29(5):308-12 - PubMed
  28. Plast Reconstr Surg. 1980 Oct;66(4):605-7 - PubMed
  29. J Plast Reconstr Aesthet Surg. 2007;60(9):1055-9 - PubMed
  30. Urology. 2012 Jun;79(6):1390-4 - PubMed

Publication Types