Introduction & Objective :
Fournier’s Gangrene (FG) is a rapidly progressive necrotizing infection of the genitalia. Despite aggressive treatment, mortality rates are reported to be as high as 67%. Much of the morbidity is incurred during the initial hospital stay after the initial debridement. Transposition of testicles into subcutaneous thigh pouches with local skin advancement is one strategy by which soft tissue defects can be repaired. The present study sought to analyze the effect of testicular transposition on length of stay and rate of complications in FG patients.
Retrospective chart review was undertaken to identify FG patients from 2009 to 2012. Abstracted data included age, sex, length of stay, BMI, mortality, tobacco and alcohol use. Comorbidities were classified based on organ system. Length of stay and complications were compared across reconstruction types (Table 1). Data were analyzed using non-paired, two tailed t-test with significance p < 0.05.
31 Male patients were identified with FG of which 20 met inclusion criteria. Patient comorbidities associated with FG included diabetes (70%), hypertension (70%), and smoking (55%). An average of 2.9 debridements were required for each patient and 80% had removal of scrotal skin. Orchiectomy was required in 15% of patients. Average time to reconstruction was 16.65 days from initial debridement. 45% of patients underwent transposition of one or more testicles with 55% also receiving local skin advancement. Skin grafting was required in 40% of patients. Testicular transposition trended towards a decreased length of stay relative to other reconstructive methods (18.82 v 28.78 days p = 0.09). Mortality was 10% for our study. Post operative complications did not vary significantly based on type of reconstruction (Table 1).
Our findings validate the diagnosis of Fournier’s gangrene as a challenging clinical paradigm requiring multidisciplinary care and often protracted hospital stays with significant morbidity. The majority of our patients were obese, diabetic, smokers with hypertension and advanced age. Further investigation through larger volume studies may validate testicular transposition with local skin advancement as the optimal reconstructive strategy to decrease length of stay in FG patients.