An Innovative Technique of Testicular Preservation in Fournier's Gangrene: Surgical Details and Illustration

Abstract

Fournier's gangrene, which is a necrotizing fasciitis of the perineal region, requires prompt control of infection with emergent surgical debridement. The shameful exposure of gonads, which occurs following debridement, can cause both physiological and psychological impairment to the patient. These can be avoided by the use of this novel technique for testicular preservation. Following debridement of necrotic scrotal skin, this technique involves creation of inguinal pouch by blunt dissection and placement of the testes in the pouch created. Once healthy granulation tissue is achieved in the scrotal wound, closure of the scrotum is performed after bringing down the testes. The advantages of this technique include development of a relatively physiological position to preserve the testes before definitive reconstruction of the scrotum and the easy reproducibility of the technique. A holistic approach to management of Fournier's gangrene should include resuscitation, administration of antibiotics, debridement, and scrotal reconstruction. However, the psychological impact of shameful exposure of the gonads must also be borne in mind during the management. Our technique represents one of the ways to reduce the stigma and discomfort associated with shameful exposure of the testes.

Keywords: fournier gangrene; scrotal surgery; shameful testes; surgical technique guide; urogenital pathology.

Figure 1. Exposed testes following debridement

The testes are shamefully exposed after removal of necrotic scrotal skin. Original image created by Sreeshanth KS

Figure 2. Creation of the right inguinal pouch

A gauze piece held with a sponge holder is used to create space via blunt dissection on the right side. Original image created by Sreeshanth KS

Figure 3. Creation of the left inguinal pouch

A gauze piece held with a sponge holder is used to create space via blunt dissection on the left side. Original image created by Sreeshanth KS

Figure 4. Placement of the testis in the right inguinal pouch

The right testis is gently pushed manually into the inguinal pouch created. Original image created by Sreeshanth KS

Figure 5. Placement of the testis in the left inguinal pouch

The left testis is gently pushed manually into the inguinal pouch created. Original image created by Sreeshanth KS

Figure 6. Clinical images of the technique of inguinal pouch creation and placement of the testes

(A) Creation of the right inguinal pouch. (B) Creation of the left inguinal pouch. (C) Placement of the testis in the right inguinal pouch. (D) Placement of the testis in the left inguinal pouch.

Figure 7. Clinical images of wound after re-debridement and primary closure of the scrotum

(A) Scrotal wound with healthy granulation tissue following re-debridement. The testes have been brought down from the inguinal pouch for inspection. (B) Primary closure of the scrotum after bringing down the testes.