Fournier’s Gangrene – Management in Rural Tertiary Centre

Background: Fournier's gangrene is a synergistic necrotizing fascitis of the external genitalia and perineal tissues that can be fatal. Young men are the most typically affected, however it can also affect women and children. The use of broad spectrum antibiotics and surgical intervention with serial wound debridement is the main stay of treatment and critical determinant of prognosis.

It's a difficult undertaking to rebuild a soft tissue defect after it's been debrided. The goal of this studyis to evaluate the surgical reconstruction methods of soft tissue defects due to Fournier's gangrene.

Methods: This prospective study included all patients with necrotizing fascitis of external genitalia and perineum, irrespective of age and gender presenting to our hospital. Age, gender, aetiology, predisposing variables, clinical characteristics, defect location, type of bacterial flora, reconstructive treatment performed, length of hospital stay, post-operative pain, patient satisfaction, and death, if any, were all investigated. The technique chosen was based on the severity of the defect, the availability of local tissue, and the patient's preferences.

Results: 31 patients underwent reconstructive procedures.

The participants ranged in age from 4 to 74 years old (mean 38.5). Pain, scrotal swelling, and fever were the most prevalent symptoms. Urogenital disorders were the most common cause. 10 patients were treated by split-thickness skin graft, 5 by secondary suturing, 2 by unilateral superomedial thigh flap, 4 by bilateral superomedial thigh flap, 5 by tensor fascia lata flap, 2 by medial thigh V-Y advancement flap, 2 with perineal artery flap and one case healed by secondary intention

Conclusion: This study reveals that the mainstays of treatment are earlier presentation, early diagnosis, and intervention with debridement and suitable antibiotics. Except in one case, soft tissue defects caused by wound debridement required surgical reconstruction, reducing morbidity, hospital stay, and patients' return to normal life.