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Dorchester Center, MA 02124
Scrotal Reconstruction
Clinical Presentation
A 76-year-old paraplegic White male with a long-standing history of diabetes developed Fournier’s gangrene and presented to the urology service. The primary service performed emergent radical surgical debridement to control the soft tissue infection. After debridement, a significantly large soft tissue wound involving the entire right ischial, gluteal, and posterior thigh regions as well as bilateral scrotal areas remained ( Fig. 39.1 ). The plastic surgery service was asked for a definitive soft tissue reconstruction. The patient’s medical conditions including diabetes were managed by the medicine service and were reasonably under control.
Operative Plan and Special Considerations
Additional surgical debridement is often necessary before a definitive soft tissue reconstruction. Based on more detailed preoperative evaluation, some parts of the open wound could be closed primarily after local tissue rearrangement or skin undermining. The rest of the open wound including the scrotum could be closed with a split-thickness skin graft (STSG). A combination of STSG and direct wound closure would be necessary for the definitive soft tissue reconstruction. The patient would almost certainly develop recurrent or new ischial pressure sores without proper nursing care.
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