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Temporary Relocation of the Testes in Anteromedial Thigh Pouches Facilitates Delayed Primary Scrotal Wound Closure in Fournier Gangrene With Extensive Loss of Scrotal Skin—Experience With 12 Cases

Okwudili, Obi Anselm MBBS, FWACS, FICS

doi: 10.1097/SAP.0000000000000505
Reconstructive Surgery
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Aims and Objectives To share our experience on the use of temporary testicular thigh pouches to facilitate scrotal wound closure in Fournier gangrene with extensive loss of scrotal skin.

Patients and Methods Patients seen over a 10-year period who had extensive (>50%) loss of scrotal skin precluding delayed primary closure of the residual scrotal skin over the testes were documented. Patients had serial debridement as required with scrotal wound dressing until healthy granulation tissue was achieved. The testes were placed temporarily in anteromedial thigh pouches to allow for scrotal wound closure. In the postoperative period, the testes were gradually massaged back into the residual scrotal pouch, thus acting as natural tissue expanders.

Results Mean patient age was 38.1 ± 10.0 years. Mean duration of admission was 24.4 ± 4.7 days. Identified predisposing factors were ischiorectal fossa abscess in 2 patients and urethral stricture in 1 patient. The rest were idiopathic. Mean Fournier gangrene severity index was 6.0 ± 1.3. Mean number of debridements was 2.3 ± 0.5. There was no mortality. The residual scrotal pouches expanded sufficiently over time (3–8 months) to accommodate the testes. Normal testicular volume was maintained in all patients. Mean testicular volume was 19.0 ± 3.2 cm3. Follow-up was for 14.8 ± 9.7 months.

Conclusions Temporarily relocating the testes in anteromedial thigh pouches facilitates scrotal wound closure in Fournier gangrene with extensive loss of scrotal skin and obviates the need for specialized reconstructive surgery.

From the Urology Unit, Department of Surgery, Federal Teaching Hospital; Department of Surgery, Ebonyi State University, Abakaliki, Nigeria.

Received October 29, 2014, and accepted for publication, after revision January 27, 2015.

Conflicts of interest and sources of funding: none declared.

Reprints: Obi Anselm Okwudili, MBBS, FWACS, FICS, Urology Unit, Department of Surgery, Federal Teaching Hospital, PMB 102 Abakaliki; Department of Surgery, Ebonyi State University, Ebonyi State Nigeria, Abakaliki, Nigeria. E-mail: draoobi@yahoo.com.

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