Post-Fournier's Gangrene Reconstruction of Perineum And Scrotum

Abstract

ournier’s gangrene is an acute, extremely aggressive, rapidly progressive and potentially fatal (from 7.5% to 40%) infective necrotizing fasciitis affecting the external genitalia or perianal regions. It commonly affects men, but can also -occur in women and children. It is caused by synergistic aerobic and anaerobic organisms (polymicrobial) that spread along fascial planes, leading to soft-tissue necrosis. It frequently stems from an infection of the ano-rectum (30-50%), uro-genital (20-40%) or genital skin (20%). Infection represents an imbalance between host immunity and the virulence of the causative microorganisms. Ultimately, an obliterative endarteritis develops, and the ensuing cutaneous and subcutaneous vascular necrosis leads to localized ischemia and further bacterial proliferation. The rate of fascial destruction is as high as 2-3 cm/h. The onset of the disease is more insidious resulting in delayed diagnosis and management. The clinical picture deteriorates rapidly within a few hours; pain is severe and usually manifests before the cutaneous signs. As the infection becomes more intense, the pain develops. The clinical image is characterized by symptoms of general toxicity. The advanced symptoms are symptoms of septic shock or multi-organ dysfunction (MODS) which frequently appear in the late phase of its subacute form. Additional symptoms pertaining to co-morbidities may also coexist. The symptoms of