A Case Of Fournier's Gangrene reconstructed by Anterioiomedial Fasciocutaneous thigh flap in Karnali Academy of Health Science, Jumla
Abstract
Fournier’s gangrene is type I necrotizing fasciitis of perineum and genital area which can extend up to the abdominal wall. The necrotizing process commonly originates from anorectum, urogenital tract or skin of genitilia due to trauma, recent surgery and presence of foreign body. In general,the infection occurs in immunosuppressed and patients with low socioeconomic levels and undernourished individuals. Vasectomy and circumcision are the rare causes among multiple causes of fournier’s gangrene1. Fournier’s gangrene is predominantly a polymicrobial infection. The responsible organism include both aerobic and anaerobic strains which act synergistically and produce enzymes like collagenase, heparinase, hylorunidase, streptokinase and streptodomase which promote rapid digestion of fascial barriers, tissue destruction and necrosis.
In general, the most common presenting symptoms of fournier’s gangrene include genital discomfort and pruritis in prodromal phase followed by scrotal swelling, pain, hyperemia, erytheme, induration, crepitus and fever which may ultimately leads to necrosis, foul smelling discharge and gangrene. It is usually associates with fever, tachycardia, dehydration, hypotension, leukocytosis, anemia and thrombocytopenia.
Often after eliminating the infection and removing the devitalized tissues, extensive open areas, mainly in the pubis, perineum, and genital region, must be covered. Major scrotal defects with exposed testes have been treated in many ways. The methods for testicular salvage have evolved from the simplest solution with skin grafting, burying them underneath the medial thigh skin, tissue expansion of adjacent tissues and use of local fasciocutaneous or musculocutaneous flaps. However, the vast majority of reconstructive options include the use of flaps, either fasciocutaneous or musculocutaneous 2.
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