Affiliation:
1. UCL Medical School , London , UK
2. University College London , London , UK
3. St. Peter's Andrology Centre and UCLH , London , UK
Abstract
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.
Publisher
Oxford University Press (OUP)
Subject
Urology,Obstetrics and Gynecology,Reproductive Medicine,Endocrinology,Endocrinology, Diabetes and Metabolism,Psychiatry and Mental health
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