Fournier's gangrene (FG) is a rarely encountered necrotizing fasciitis principally affecting the skin and the subcutaneous tissues of the genital region, perineum, and abdominal wall. The overall incidence of FG is 1.6 cases per 100 000 per year, predominantly affecting the older male population. A recent study suggests that the Limberg flap technique is a better approach for scrotal reconstruction following FG. The research has been published in the journal Wounds by March 2021.
Management techniques described in the literature have both advantages and disadvantages, and there is no gold standard treatment technique. Multiple debridements should continue until healthy tissues are seen, which may lead to functional, aesthetic, and psychological problems in these patients. Therefore, Dr Mehmet Dadaci and his team conducted a study to evaluate whether the Limberg flap can be used reliably in scrotal defects with fewer complications than are seen with traditional techniques. They also assessed the results of unilateral or bilateral Limberg flaps for scrotal reconstruction after FG.
It was a retrospective, single-centre study that analyzed records from 29 male patients with scrotal defects after multiple debridements. Among 29 patients, 21 patients (72.4%) had hemiscrotal defects and 8 patients (27.6%) had defects involving greater than 50% of the scrotal surface. The researchers analyzed the demographic data that include smoking history, comorbid conditions, time of surgery, and time of follow-up. They further evaluated the flap dimension and evaluated the patients in terms of flap viability and postoperative complications.
Key findings of the study were:
The researchers observed dehiscence with seroma in 4 patients (13.7%) on postoperative days 4 and 5.
The average size of the flaps was 11 cm × 15 cm.
They identified seroma and dehiscence were encountered in 4 patients (13.7%) during postoperative follow-ups.
They observed no postoperative infection in any patients and reported no partial or total flap loss.
The authors concluded, "These results suggest that use of the Limberg flap technique for scrotal reconstruction following FG has the important benefits of being easily harvested while providing tension-free repair and acceptable cosmetic results."
For further information:
Dadaci M, Yildirim MEC, Yarar S, Ince B. Assessment of Outcomes After Limberg Flap Reconstruction for Scrotal Defects in Patients With Fournier's Gangrene. Wounds. 2021 Mar;33(3):65-69.