.: ORİJİNAL ARAŞTIRMA
Closure of the Scrotal Defect Due to Fournier's Gangrene with Relieved Contracted Scrotal Flaps by Scoring Incisions: Descriptive Research
Fournier Gangrenine Bağlı Skrotal Defektlerin Skorlama İnsizyonuyla Rahatlatılarak Skrotal Fleplerle Kapatılması: Tanımlayıcı Araştırma
J Reconstr Urol. 2022;12(2):70-6
doi: 10.5336/urology.2022-90263
Makale Dili: EN
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ABSTRACT
Objective: Fournier's gangrene is an insidious disease that occurs in the scrotal, perianal, and genital regions where aerobic and anaerobic bacteria form micro thromboses, causing tissue necrosis and extending to the fascia and spreading to the trunk and extremities. This disease, which is more common in male patients, patients with diabetes mellitus, immunocompromised patients, and those undergoing surgical procedures has high morbidity and mortality. We present the scoring incision of scrotal flaps that we apply in our clinic and the approximation suture technique with appropriate tension. Material and Methods: A study was conducted between January 2016 and July 2021; patients whose primary surgical debridement procedures were terminated after Fournier's gangrene were hospitalized in our clinic to close their defects. The study examined data such as mean age, defect size and localization, accompanying diseases, reproducing microorganisms, duration of surgery, duration of hospitalization, the healing time of wounds, and complications. Results: The mean age of the patients was 61.1 years, and the most common comorbidities were diabetes mellitus and respiratory tract disease. Beta-hemolytic streptococci were the most prolific microorganism. The defects were closed in 4-7 weeks in all patients. Conclusion: In scrotum defects that occur after Fournier's gangrene, the approximating suture technique performed at appropriate tension after the release of the contractures of scrotal flaps with scoring incision provides good stretching of the scrotal flaps and closure of the wounds at appropriate times.
Keywords: Fournier's gangrene; scoring incision; scrotal flap; wound approximation
Objective: Fournier's gangrene is an insidious disease that occurs in the scrotal, perianal, and genital regions where aerobic and anaerobic bacteria form micro thromboses, causing tissue necrosis and extending to the fascia and spreading to the trunk and extremities. This disease, which is more common in male patients, patients with diabetes mellitus, immunocompromised patients, and those undergoing surgical procedures has high morbidity and mortality. We present the scoring incision of scrotal flaps that we apply in our clinic and the approximation suture technique with appropriate tension. Material and Methods: A study was conducted between January 2016 and July 2021; patients whose primary surgical debridement procedures were terminated after Fournier's gangrene were hospitalized in our clinic to close their defects. The study examined data such as mean age, defect size and localization, accompanying diseases, reproducing microorganisms, duration of surgery, duration of hospitalization, the healing time of wounds, and complications. Results: The mean age of the patients was 61.1 years, and the most common comorbidities were diabetes mellitus and respiratory tract disease. Beta-hemolytic streptococci were the most prolific microorganism. The defects were closed in 4-7 weeks in all patients. Conclusion: In scrotum defects that occur after Fournier's gangrene, the approximating suture technique performed at appropriate tension after the release of the contractures of scrotal flaps with scoring incision provides good stretching of the scrotal flaps and closure of the wounds at appropriate times.
Keywords: Fournier's gangrene; scoring incision; scrotal flap; wound approximation
ÖZET
Amaç: Fournier gangreni, skrotal, perianal ve genital bölgelerde aerobik ve anaerobik bakterilerin mikro tromboz oluşturarak doku nekrozuna neden olması sonrası fasiyaya uzanarak gövde ve ekstremitelere yayılan sinsi bir hastalıktır. Erkek hastalarda, diyabet hastalarında, bağışıklığı baskılanmış hastalarda ve cerrahi işlem geçirenlerde daha sık görülen bu hastalık aynı zamanda yüksek morbidite ve mortaliteye sahiptir. Bu çalışmada, kliniğimizde uyguladığımız skrotal fleplerin skorlama kesisini ve uygun gerginlikte yaklaşım dikiş tekniğini sunmak amaçlanmıştır. Gereç ve Yöntemler: Fournier gangreni sonrası primer cerrahi debridman işlemleri sonlandırılan hastalar defektlerinin kapatılması için kliniğimize yatırılan hastalar Ocak 2016-Temmuz 2021 tarihleri arasında retrospektif olarak tarandı. Çalışmada; ortalama yaş, defekt boyutu ve lokalizasyonu, eşlik eden hastalıklar, üreyen mikroorganizmalar, ameliyat süresi, hastanede yatış süresi, yaraların iyileşme süresi ve komplikasyonlar gibi veriler incelendi. Bulgular: Hastaların ortalama yaşı 61,1 yıl olup, en sık eşlik eden hastalıklar diabetes mellitus ve solunum yolu hastalığıdır. Beta-hemolitik streptokoklar en çok üreyen mikroorganizmalardır. Tüm hastalarda 4-7 haftada defektler kapatılmıştır. Sonuç: Fournier gangreni sonrası oluşan skrotum defektlerinde skrotal fleplerin kontraktürleri skorlama insizyonu ile gevşetildikten sonra uygun gerginlikte yapılan yaklaştırma sütür tekniğiyle skrotal fleplerin iyi bir şekilde esnetmekte ve yaraların uygun zamanlarda kapatılmasına olanak sağlamaktadır.
Anahtar Kelimeler: Fournier gangreni; skorlama insizyonu; skrotal flep; yara yaklaştırma
Amaç: Fournier gangreni, skrotal, perianal ve genital bölgelerde aerobik ve anaerobik bakterilerin mikro tromboz oluşturarak doku nekrozuna neden olması sonrası fasiyaya uzanarak gövde ve ekstremitelere yayılan sinsi bir hastalıktır. Erkek hastalarda, diyabet hastalarında, bağışıklığı baskılanmış hastalarda ve cerrahi işlem geçirenlerde daha sık görülen bu hastalık aynı zamanda yüksek morbidite ve mortaliteye sahiptir. Bu çalışmada, kliniğimizde uyguladığımız skrotal fleplerin skorlama kesisini ve uygun gerginlikte yaklaşım dikiş tekniğini sunmak amaçlanmıştır. Gereç ve Yöntemler: Fournier gangreni sonrası primer cerrahi debridman işlemleri sonlandırılan hastalar defektlerinin kapatılması için kliniğimize yatırılan hastalar Ocak 2016-Temmuz 2021 tarihleri arasında retrospektif olarak tarandı. Çalışmada; ortalama yaş, defekt boyutu ve lokalizasyonu, eşlik eden hastalıklar, üreyen mikroorganizmalar, ameliyat süresi, hastanede yatış süresi, yaraların iyileşme süresi ve komplikasyonlar gibi veriler incelendi. Bulgular: Hastaların ortalama yaşı 61,1 yıl olup, en sık eşlik eden hastalıklar diabetes mellitus ve solunum yolu hastalığıdır. Beta-hemolitik streptokoklar en çok üreyen mikroorganizmalardır. Tüm hastalarda 4-7 haftada defektler kapatılmıştır. Sonuç: Fournier gangreni sonrası oluşan skrotum defektlerinde skrotal fleplerin kontraktürleri skorlama insizyonu ile gevşetildikten sonra uygun gerginlikte yapılan yaklaştırma sütür tekniğiyle skrotal fleplerin iyi bir şekilde esnetmekte ve yaraların uygun zamanlarda kapatılmasına olanak sağlamaktadır.
Anahtar Kelimeler: Fournier gangreni; skorlama insizyonu; skrotal flep; yara yaklaştırma
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