Fournier’s gangrene: challenges and pitfalls for genital reconstruction from a tertiary hospital in South Africa
AbstractBackground: Fournier’s gangrene (FG) is an acute urological emergency described as a necrotising soft-tissue infection of the genitalia and perineum with associated polymicrobial infection, organ failure and death. The use of broad-spectrum antibiotics and immediate surgical debridementare the mainstays of treatment. The extensive debridement of all the necrotic tissue, the associated wound care and the reconstruction of the defect remain a big challenge. The prevalence in low-income countries such as South Africa seems to be higher when compared to international statistics despite the lack of published data. Patients and methods: A descriptive retrospective study was performed for the period of January 2006 up to December 2015 at Kimberley Hospital Complex, a facility which provides tertiary services to the Northern Cape Province (NCP) in South Africa. A search for all patients who underwent reconstructive procedures following the successful management of FG was performed using the Department of Plastic and Reconstructive Surgery’s database. Challenges and pitfalls for the performance of the reconstruction were analysed. Results: Sixty-four male patients underwent genital reconstruction after FG debridement. The age range was 16 to 78 years (mean 52.75). Fifty-six (87.5%) of the patients were referred from rural areas of the NCP. Fifty-nine (92.2%) were reconstructed with split-thickness skin grafting; of these 14% had initial partial graft failure. Most patients were referred from rural areas after debridement with suboptimal wound care and lack of management of the testicles which needed to be optimised before the reconstructive procedure. Conclusions: Due to this high prevalence, lack of resources and severity of the disease, many general practitioners are expected to assist the patient diagnosed with FG by performing the initial and life-saving debridement. This proves to be a challenge for the less experienced doctor, who is expected to refer the patient to other centres for reconstructive procedures. Based on our experience, we analysed the challenges and pitfalls encountered and provided some strategies for the referring practitioner to perform surgical management for a better reconstructive outcome.
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