Fournier’s Gangrene: A Case Report.

Fournier’s gangrene is a rare, idiopathic, life-threatening, necrotizing fasciitis of the genitals and perineum caused by both aerobic and anaerobic bacterial flora. The synergistic effect of the bacteriae results in fulminating gangrene, multiple organ failure, and can even lead to death. Most commonly it has a predilection for diabetic and alcohol abused individuals, those who have impaired immunity. Genital trauma is frequently recognized vector for infection initiation. Timely recognition of the disease process and initiation of treatment with aggressive debridement and antibiotic administration is called for. The advanced age of the patient, extensive disease, delayed presentation with shock or sepsis and organ failures, all contribute to mortality in Fournier’s gangrene. In this case report, we recall an account of our tryst with Fournier’s gangrene management.

Parâmetros anátomo-estruturais de orgãos reprodutivos de ovinos sem raça definida (SRD) nativos do Estado da Paraíba, com e sem bipartição escrotal: estudo do escroto e funículo espermático / Anatomical and structural parameters of reproductive organs of crossbred rams native from the state of Paraíba, Brazil, with and without scrotal bipartition: study of the scrotal skin and spermatic cord

Foram utilizados 42 ovinos sem raça definida, divididos segundo a configuração escrotal. Destes animais, 12 foram utilizados na investigação da biometria testicular e histologia da pele escrotal. Os demais foram destinados ao estudo do funículo espermático. Os animais foram agrupados em um grupo de 21 animais sem bipartição escrotal (GEI) e 21 com bipartição escrotal, (GEII), esta não atingindo 50% do comprimento do eixo longitudinal do escroto. Em cada grupo, em 6 animais foram coletados fragmentos da pele do escroto e em 5 do funículo espermáticos, e processados em rotina histológica e analisados em microscopia de luz; e em 10 foram injetados látex na artéria testicular para obtenção de moldes vasculares e obtenção do comprimento da artéria. Quando comparados os grupos GEI e GEII, não foram encontradas diferenças estatísticas significativas (p<0,05) entre a espessura do escroto (epiderme e derme), constituição histológica da pele escrotal, número de glândulas sudoríparas por área, comprimento do funículo espermático ou parâmetros biométricos testiculares. Entretanto, o comprimento total das artérias testiculares do GEI foi maior do que o GEII (p<0,05). Concluiu-se, com base nos parâmetros morfológicos analisados, que a bipartição escrotal em ovinos não influenciou na estrutura da pele, funículo ou biometria testicular quando comparado aos animais que não apresentavam esta característica. Outros estudos merecem atenção para desmistificar o porquê do aparecimento dessa característica em ovinos e se esta característica é ou não desejável para melhoria na produção desses animais em regiões de clima quente.

Forty-two crossbred rams were used, divided according to their scrotal configuration. Twelve of these animals were used to investigate the testicular biometry and scrotal skin histology. The other animals were used to study the spermatic cord. The animals were placed in a group of 21 animals without scrotal bipartition (GEI) and another with scrotal bipartition (GEII) which did not reach 50% of the length of the scrotum's longitudinal axis. In each group, scrotal skin fragments from six rams and spermatic cord fragments from 5 others were collected, processed by routine histological tests and analyzed with a microscope. In 10 rams latex was injected into the testicular artery to obtain vascular molds and the artery length. Comparison of groups GEI and GEII showed no significant statistical differences (p<0.05) between scrotal thickness (epidermis and dermis), histological constituency of the scrotal skin, number of sudoriferous glands per area, scrotal bipartition length or testicular biometric parameters. However, the total length of the testicular arteries of GEI was greater than of GEII (p<0.05). It was concluded from the morphological parameters analyzed that scrotal bipartition in rams did not influence the skin structure, scrotal bipartition or testicular biometry when compared with animals that did not present this characteristic. Further studies should be carried out to elucidate the appearance of this characteristic in rams and whether it is desirable or not for improved production of these animals in warm climate regions.

Reconstrucción del pene post circuncisión: evidencias de un caso / Penile Reconstruction post circumcision: case report

Las heridas del pene no son frecuentes y pueden ser ocasionadas por caídas sobre objetos cortantes o por la cremallera del pantalón, heridas de armas de fuego, por bandas de estrangulación, que pueden ser provocadas por bandas de manguitos o la utilización de mangueritas de gomas, cordeles, cabellos, etc7. Estos medios interrumpen la circulación linfática y venosa, lo cual desarrolla un gran edema y puede producir lesiones isquémicas y necrosis de la piel8. También se han reportado casos por mordeduras y amputaciones2. El caso que estamos reportando es de un niño de 1 año de edad de bajo nivel sociocultural que vive en las Islas Galápagos y que fue transferido al hospital del Niño “Dr. Francisco de Ycaza Bustamante” y atendido en la consulta externa del Servicio de Cirugía Plástica por presentar la falta de cubierta cutánea del pene e implantación directa del glande en la piel del pubis como resultado de una circuncisión realizada a los seis meses de edad. La reparación se la planificó en dos tiempos, en el primero se liberó el cuerpo del pene y se lo “enterró” en un túnel escrotal. En el segundo se utilizó la pared anterior del escroto para obtener una piel muy semejante a la original, resistente y sobre todo muy elástica que permita una mejor función. Se evitó realizar suturas lineales y circulares para prevenir cicatrices retráctiles.

Penile trauma are not frequent and can be caused by falling over sharp objects, zipper, gun shot wounds, amputations usually self inflicted or from clothing trapped by heavy machinery and strangulations from penile rings to enhance erection. They interrupt lymphatic and venous circulation which causes edema, necrotic and isquemic lesions of the skin. We have a case of one year old boy of low social economic status who lives in the island of Galapagos. He was transferred to the division of Plastic Surgery at the Dr. Francisco de Ycaza Bustamente Children’s Hospital for missing shaft skin of the penis and the having the glans of the penis pulled down into the pubic fat as a result of a circumcision done at 6 months of age. The penis is forced into a subcutaneous position by wound contraction following circumcision. This may be produced if there is a tendency of the penis to retract into the fatty pubis, and later the circular wound heals, contracts and holds the penis in a submerged position beneath the pubic skin. The corrective surgery was done in two parts. The first operation was liberating the shaft of the penis and burying it into the scrotal tunnel. The second surgery was performing skin grafting using the anterior wall of the scrotum because it is the similar to the original, resistant and flexible for better function. Linear and circular sutures were to prevent the wound to contract.

Vaginoplasty Using Penile and Scrotal Skin Flap in Male Transsexualism

Male transsexualism is characterized by a life-long preference for the feminine role and the conviction of belonging to the female sex. The final and most characteristic expression of transsexualism is the desire to achieve the anatomical appearance of the opposite sex by either surgical or hormonal means. Since the skin graft technique of McIndoe, a number of operative procedures were evolved. Nowadays in order to construct neovaginas in male transsexuals, the inversion of penile flap or that of penile and scrotal skin flap is performed as a primary trial. Penile and scrotal skin flap have better functional results, but the cosmetic results are not satisfactory because of the prolapse of scrotal skin. In our studies, the vaginoplasty using penile and scrotal skin flap has been successfully used for 26 male transsexuals in whom their penis and scrotum were well preserved. We used scrotal skin flap modified by 8 cm wide. Additionally we made partial prepuce with dorsal neurovascular bundle into neoclitoris. Follow-up period ranged from 4 months to 22 months. The depth and width of neovagina was desirable. The cosmesis and physiologic benefit to the patient's satisfaction with the operation were reliable.

Repair of skin defect in penis with scrotal skin flap / 中华医学美学美容杂志

Objective To explore a simple and convenient method for the treatment of penis skin defect.Methods Since Jan.1995,the scrotal skin flaps have been used to repair the defects of the penis skin in 8 patients with penis skin infection.6 of these cases lost their whole penis skin,and 2 of them lost 2/3 of their penis skin.The granulation tissues in the defective area of penis skin were cut away,and then the normal aponeurosis of corpus cavernosum or spongiosum exposed.The scrotal skin flaps were designed and shaped.The flaps were transferred to cover the defects,and the incisions were closed.Results All the flaps in 8 cases survived completely.The follow-up period was 3 to 12 months after operation.All cases obtained satisfactory results to the contour and function of the penises.Conclusion This procedure is a much better method for repairing skin defects in the penis.It can be easily operated and completed in one-stage.The postoperative results are satisfactory.

"Apron Method", Scrotal Flap in Totally Denuded Penis due to Paraffinoma / 대한비뇨기과학회지

The loss of penile skin, either traumatic or iatrogenic, is sometimes difficult to treat. The classical modes of surgical treatment are a thick split thickness graft and burial beneath the scrotal skin. Apron method, one stage penoplasty using the scrotal skin flap in the treatment of penile denudation, is reported herein.

Deepithelialized Scrotal Skin Flap in Repair of Urethrocutaneous Fistula and Urethroplasty / 대한비뇨기과학회지

Eight patients undergoing closure of urethrocutaneous fistula and 15 patients undergoing urethroplasty for hypospadias were reviewed. Most of fistulas were presented in the penoscrotal level. Fistulas were closed using a deepithelialized scrotal skin flap. Of 8 patients with fistulas were repaired by this method there were no recurrences and 3 were performed without urinary diversion or urethral stenting. Of l5 patients with hypospadias undergoing urethroplasty using a deepithelialized scrotal flap there were no fistulas in the original urethral opening area but a fistula distal to the original urethral opening was found in 3 patients This technique is very satisfactory in repair of the complicated as well as the simple urethrocutaneous fistulas which can be done without urinary diversion or urethral stenting and seems to be useful in reducing fistula formation following urethroplasty in hypospadias.