Reconstruction of the Necrotic Scrotum with Hydrosurgery System and Pedicle DIEP Flap: A Case Report of Fournier Gangrene

Abstract

Despite medical advances, the mortality rate associated with Fournier gangrene has remained largely unchanged and extremely high. In addition, conventional surgical treatment of Fournier gangrene of the scrotum requires excision of the testicles in some cases, which can result in loss of fertility. We report herein the favorable results of reconstruction of the scrotum following Fournier gangrene, using the hydrosurgery system and pedicled deep inferior epigastric perforator flap. A 60-year-old male patient was urgently transported to our hospital for fever, lower abdominal pain, and scrotal pain for several days. He was diagnosed with Fournier gangrene and underwent an emergency debridement procedure on the same day. Later, we performed a 2-phase reconstruction with a hydrosurgery system and pedicled deep inferior epigastric perforator flap under general anesthesia for the postoperative tissue defect. At 6 months postoperatively, there was no ulceration or scar contracture, and the results were aesthetically pleasing. There are no reported cases of reconstruction of the scrotum following Fournier gangrene using this procedure, and it might be an effective treatment option.

Fig. 1.

Appearance of Fournier gangrene of the scrotum during the emergency debridement. The black necrotic skin and subcutaneous tissue from the scrotum to the perineum were excised, and the perineum was excised from the anus up to 2 cm anteriorly.

Fig. 2.

Intraoperative findings of debridement using hydrosurgery. A hydraulic debridement was performed until a good bleeding point was located using HS.

Fig. 3.

Intraoperative findings of hydrosurgery. The remaining necrotic tissue was then removed to freshen the superficial tissue.

Fig. 4.

Intraoperative findings of a DIEP flap reconstruction of scrotal tissue defects. A 15 × 8 cm pedicled DIEP flap from the left side of the abdomen was elevated and transferred through a subcutaneous tunnel into the scrotal tissue defect.

Fig. 5.

Scrotal findings at 6 months after reconstructive surgery. There was no ulceration or scar contracture, and the results were aesthetically pleasing.