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Open Access Case report

Management of unusual genital lymphedema complication after Fournier’s gangrene: a case report

Oanna Meyer Ganz1*, Raphaël Gumener1, Pascal Gervaz2, Julien Schwartz3 and Brigitte Pittet-Cuénod1

Author Affiliations

1 Division of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Geneva, Switzerland

2 Department of Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Geneva, Switzerland

3 Division of Urology, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Geneva, Switzerland

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BMC Surgery 2012, 12:26  doi:10.1186/1471-2482-12-26

Published: 23 December 2012

Abstract

Background

Fournier’s gangrene is a bacterial infection characterized by necrotizing fasciitis, skin and soft tissue involvement, and eventually myositis of the perineal region. Aggressive debridement of devitalized tissue and overlying skin is of paramount importance, but often leaves large defects to be reconstructed. The present case reports successful extensive perineal defects coverage following Fournier’s gangrene and management of subsequent penile lymphoedema impairing sexual function in a young patient.

Case presentation

Following perianal abscess drainage, a healthy young man presented with scrotal pain. Fournier’s gangrene was diagnosed and treated with multiple surgical debridements. Tissue excision extended through the entire perineal area, base of the penile shaft, lower abdominal region, the inner thighs, and gluteal region, corresponding to 12% of the total body surface area. After serial debridements and negative pressure dressings, the defect was covered by two stages of skin grafting. Graft take was 90%. Healing was achieved without hypertrophic or retractile scar. However, chronic penile lymphedema remained and was first treated with compressive garments for 2 years. Upon failure of this conservative approach, we performed a circumcision, but only a “penile lift” allowed a satisfactory esthetical and functional result.

Conclusion

Fournier’s gangrene can be complicated by a chronic lymphedema of the penis. Conservative treatment is likely to fail in severe cases and can be treated surgically by “penile lift”.

Keywords:
Fournier’s gangrene; Penile lymphedema; Negative pressure wound therapy; Perineal reconstruction