Reconstruction of Perineal Defects after Fournier's Gangrene

福爾尼埃氏壞疽後會陰部缺損的重建

王冠穎(Kuan-Ying Wang) ； 朱益民(Yih-Min Chu) ； 陳理維(Lee-Wei Chen) ； 楊國強(Kuo-Chung Yang) ； 謝宇軒(Yu-Hsuan Hsieh) ； 劉文忠(Wen-Chung Liu)

《臺灣整形外科醫學會雜誌》 27卷4期 (2018/12) Pp. 263-272

摘要

Background: Aggressive debridement of Fournier's gangrene often results in skin and soft-tissue defects over the perineum. Various types of reconstruction methods had been reported. However, the suggestion for reconstruction is inconclusive. Aim and objectives: Given that various reconstruction methods have been reported, we herein review our experience with patients in order to provide appropriate advice according to such. Materials and Methods: This is a retrospective review in a single center (Kaohsiung Veterans General Hospital) study spanning from 2001 to 2015. Underlying characteristics and outcomes in patients who had undergone different reconstructive surgeries after Fournier's gangrene were analyzed. Results: Among the 153 cases diagnosed with Fournier's gangrene at Kaohsiung Veterans General Hospital, 123 survived. Moreover, 21 patients underwent reconstructive surgery, of whom 17 were reviewed. 4 patients only underwent skin graft and 13 patients underwent flap reconstruction. Severely ill patients tended to undergo split-thickness skin graft reconstruction. There were both one failure in skin graft and flap group. The failure rate in skin graft only group and flap group is 25% (1/4) and 7.7% (1/13), respectively. No significant differences in failure rate were observed between skin graft only group and flap reconstruction group after adequate debridement (p=0.382). Conclusion: From our experience, it is feasible that we can use simpler reconstruction methods, such as local advancement flap or skin grafting, for severely-ill patients (ASA ＞3) and use flap reconstruction for wound coverage in stable patients presenting huge scrotal defects.

關鍵字

Fournier's gangrene ； perineal defect ； perineal reconstruction

並列摘要

背景：福爾尼埃氏壞疽清創過後常常會造成會陰部的皮膚與軟組織缺損，文獻報告了許多種重建方法，但對於重建的建議仍然是沒有明確結論。目的與目標：由於有許多種重建方法，我們想藉由回溯我們的病人來得到適當的建議。材料與方法：本篇是一個高雄榮民總醫院的病歷回溯性性研究，回溯的時間為2001年至2015年，褔爾尼埃氏壞疽重建手術的病人基本資料與結果都納入做分析。結果：高雄榮民總醫院有153個病人診斷為褔爾尼埃氏壞疽，其中123個人存活，21個人有進行重建手術，其中17個人有納入做分析，4個人只單獨接受分層皮膚移植，13個人有接受皮瓣手術。病情較嚴重的病人傾向於單純使用分層皮膚移植，兩組都各有一個病人重建手術失敗，分層皮膚移植與皮瓣手術的失敗率分別25%(1/4)與7.7%(1/13)，單獨皮膚移植手術與皮瓣手術的成功率沒有差異(p=0.382)。結論：從我們的經驗裡，在病況不佳(American Society of Anesthesiologists (ASA) Physical classification＞3)的病人給予簡單的重建手術，如局部皮瓣與皮膚移植手術，而在病況較好(ASA＜3)且其缺損較大的病人，給予皮瓣皮瓣重建是一個可行的原則來達到傷口癒合。