Isolated Penile or Scrotal Post-Fournier’s Gangrene Sequelae, the Role of Electro-Photo-Biomodulation in Conservative Treatment

Document Type : Research article

Authors

The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Tanta University

Abstract

Introduction: Jean Alfred Fournier first described Fournier’s
gangrene in 1883 as a quickly progressing and possibly
fatal necrotizing fasciitis of the skin and soft tissue of the scrotum,
perineal region, along with the abdominal wall. The best
method of reconstruction is still debatable now.
Objective: To evaluate the effect of E-light in management
of post-fournier’s gangrene sequelae.
Patients and Method: Sixteen male patients with isolated
penile or scrotal post-Fournier’s gangrene raw area participated
in this study to be treated by E-light sessions.
Results: Twelve patients (75%) had an excellent satisfaction
rate, and four (25%) rated it as good. No fair or poor results
were documented.
Conclusion: We recommend the utilization of E-light in
the management of post-Fournier’s gangrene isolated raw areas
of the scrotum and penis as it is an efficient, simple, and
cheap treatment with satisfactory results and no complications

Keywords

Main Subjects


Eke N.: Fournier’s gangrene: A review of 1726 cases.
Br. J. Surg., 87 (6): 718-28. Kılıç A., Aksoy Y., Kulik A.
Fournier’s gangrene: Etiology, treatment, and complications.
Ann. Plast. Surg., 47 (5): 523-7, 2001.
2- Kılıç A., Aksoy Y. and Kılıç A.: Fournier’s gangrene: Etiology,
treatment, and complications. Ann. Plast. Surg., 47
(5): 523-7, 2001.
3- Chen S.Y., Fu J.P., Chen T.M. and Chen S.G.: Reconstruction
of scrotal and perineal defects in Fournier’s gangrene.
J. Plast. Rec. Aest. Surg., 64 (4): 528-34, 2011.
4- Hasdemir A.O., Büyükaşik O. and Cöl C.: The clinical
characteristics of female patients with Fournier’s gangrene.
Int. Urogynecol J. Pelvic Floor Dysfunct., 20 (12):
1439-43, 2009.
5- Karian L.S., Chung S.Y. and Lee E.S.: Reconstruction of
Defects after Fournier Gangrene: A Systematic Review.
Eplasty, 15: e18, 2015.
6- Abid S., Mir M., Haroon R., et al.: Reconstruction of soft
tissue defects in Fournier’s gangrene at a tertiary care
center. Int. J. Res. Med. Sci., 4 (10): 4341-4318, 2016.
7- Orringer J.S., Kang S., Johnson T.M., Karimipour D.J.,
Hamilton T., Hammerberg C., Voorhees J.J. and Fisher
G.J.: Connective tissue remodeling induced by carbon
dioxide laser resurfacing of photodamaged human skin.
Arch. Dermatol., 140: 1326-1332, 2004.
8- Negishi K., Wakamatsu S., Kushikata N., Tezuka Y., Kotani
Y. and Shiba K.: Full-face photorejuvenation of photodamaged
skin by intense pulsed light with integrated
contact cooling: Initial experiences in Asian patients. Lasers
Surg. Med., 30 (4): 298-305, 2002.
9- Prieto V.G., Diwan A.H., Shea C.R., Zhang P. and Sadick
N.S.: Effects of intense pulsed light and the 1,064 nm Nd:
YAG laser on sun-damaged human skin: Histologic and
immunohistochemical analysis. Dermatol. Surg., 31 (5):
522-525, 2005.
10- Amano N., Takai S., Jin D., Ueda K. and Miyazaki M.:
Possible roles of mast cell-derived chymase for skin rejuvenation.
Lasers Med. Sci., 24 (2): 223-229, 2009.
11- Yaghmai D., Garden J.M., Bakus A.D., Spenceri E.A., et
al.: Hair removal using a combination of the radiofrequency
and intense pulsed light source. J. Cosmet Laser Ther.,
6 (4): 201-207, 2009.
12- Elmelegy N. and El Sakka D.M.: Intensive pulsed light,
radiofrequency, and cooling in the aesthetic treatment of
unpleasant facial scars. J. Clin. Exp. Dermatol. Res., 6 (4).
DOI:10.4172/2155-9554.10000296.2015.
13- Gold M.H., Biron J.A. and Sensing W.: Facial skin rejuvenation
by combination treatment of IPL followed by continuous
and fractional radiofrequency. J. Cosmet. Laser
Ther., 18 (1): 2-6, 2016.
14- Garden J.M., Zelickson B., Gold M.H., Friedman D., et
al.: Home hair removal in all skin types with a combined
radiofrequency and optical energy source device. Dermatol.
Surg., 40 (2): 142-151, 2014.
15- Elmelegy N. and EL Sakka D.M.: Electrophoto-biomodulation
in the aesthetic treatment of postburn hypopigmentation
clinical response in relation to histopathological
changes. Ann. Plast. Surg., 79 (3): 264-269, 2017.
16- Taub A.F. and Devita E.C.: Successful treatment of erythematotelangiectatic
with rosacea with pulsed light and
radiofrequency. J. Clin. Aesthet. Dermatol., 1 (1): 37-40,
2008.
Vol. 48, No. 1 / Isolated Penile or Scrotal Post-Fournier’s G 6 angrene Sequelae
17- Carvalho J.P., Hazan A., Cavalcanti A.G. and Favorito
L.A.: Relation between the area affected by Fournier’s
gangrene and the type of reconstructive surgery used. A
study with 80 patients. Int. Braz J. Urol., 33: 510-4, 2007.
18- Akilov O., Pompeo A., Sehrt D., Bowlin P., Molina W.R.
and Kim F.J.: Early scrotal approximation after hemiscrotectomy
in patients with Fournier’s gangrene prevents
scrotal reconstruction with a skin graft. Can Urol. Assoc.
J., 7: E481-5, 2013.
19- Okeke L.I.: Fournier’s gangrene in Ibadan. Afr. J. Med.
Sci., 29: 323-4.
20- Campbell R.M. (1957): Dermatome grafting of the totally
denuded testes. Plast. Reconstr. Surg., 19: 509-13, 2000.
21- Bhatnagar A.M., Mohite P.N. and Suthar M.: Fournier’s
gangrene: A review of 110 cases for etiology, predisposing
conditions, microorganisms, and modalities for coverage
of necrosed scrotum with bare testes. N. Z Med. J., 121:
46-56, 2008.
22- Tan B.K., Rasheed M.Z. and Wu W.T.: Scrotal reconstruction
by testicular apposition and wrap-around skin grafting.
J. Plast. Reconstr. Aesthet. Surg., 64: 944-8, 2011.
23- Tiwari I.N., Seth H.P. and Mehdiratta K.S.: Reconstruction
of the scrotum by thigh flaps. Plast. Reconstr. Surg.,
66: 605-7, 1980.
24- Yu P., Sanger J.R., Matloub H.S., Gosain A. and Larson
D.: Anterolateral thigh fasciocutaneous island flaps in
perineoscrotal reconstruction. Plast. Reconstr. Surg., 109:
610-6, discussion 617-8, 2002.
25- Chen S.Y., Fu J.P., Chen T.M. and Chen S.G.: Reconstruction
of scrotal and perineal defects in Fournier’s gangrene.
J. Plast. Reconstr. Aesthet. Surg., 64: 528-34, 2011.
26- Ferreira P.C., Reis J.C., Amarante J.M., et al.: Fournier’s
gangrene: A review of 43 reconstructive cases. Plast. Reconstr.
Surg., 119: 175-84, 2007.
27- Parkash S. and Gajendran V.: Surgical reconstruction of
the sequelae of penile and scrotal gangrene: A plea for
simplicity. Br. J. Plast. Surg., 37: 354-7, 1984.
28- Por Y.C., Tan B.K., Hong S.W., et al.: Use of the scrotal
remnant as a tissue-expanding musculocutaneous flap for
scrotal reconstruction in Paget’s disease. Ann. Plast. Surg.,
51: 155-60, 2003.
29- Boukind H., Ezzoubi M., Chafiki N., et al.: Scrotal reconstruction
after necrotizing cellulitis of the perineum and
external genital organs. Apropos of 21 cases. Ann. Urol.
(Paris), 29: 308-12, 1995.
30- El-Khatib H.A.: V-Y fasciocutaneous pudendal thigh flap
for repair of the perineum and genital region after necrotizing
fasciitis: Modification and new indication. Ann.
Plast. Surg., 48: 370-5, 2002.
31- Coskunfirat O.K., Uslu A., Cinpolat A. and Bektas G.: Superiority
of medial circumflex femoral artery perforator
flap in scrotal reconstruction. Ann. Plast. Surg., 67: 526-
30, 2011.
32- Karac¸ al N., Livaoglu M., Kutlu N. and Arvas L.: Scrotum
reconstruction with neurovascular pedicled pudendal
thigh flaps. Urology, 70: 170-2, 2007.
33- Hsu H., Lin C.M., Sun T.B., Cheng L.F. and Chien S.H.:
Unilateral gracilis myofasciocutaneous advancement flap
for single-stage reconstruction of scrotal and perineal defects.
J. Plast. Reconstr. Aesthet. Surg., 60: 1055-9, 2007.
34- Lee S.H., Rah D.K. and Lee W.J.: Penoscrotal reconstruction
with gracilis muscle flap and internal pudendal artery
perforator flap transposition. Urology, 79: 1390-4, 2012.
35- Spyropoulou G.A., Jeng S.F., Demiri E., Dionyssopoulos
A. and Feng K.M.: Reconstruction of perineoscrotal
and vaginal defects with pedicled anterolateral thigh flap.
Urology, 82: 461-5, 2013.
36- Basil M. Hantash, Anan Abu Ubeid, Hong Chang, Reza
Kafi and Bradley Renton: Bipolar Fractional Radiofrequency
Treatment Induces Neoelastogenesis and Neocollagenesis
Lasers in Surgery and Medicine, 41: 1-9, 2009.
37- John Moffett, Nicole J. Kubat, Nicole E. Griffin, Mary C.
Ritz, Frank R. George: Pulsed radio frequency energy field
treatment of cells in culture: Increased expression of genes
involved in angiogenesis and tissue remodeling during
wound healing. The Journal of Diabetic Foot Complications,
3 (2): 30-39, 2011.
38- Seng-Feng Jeng, Jian-A Chen, Li-Ren Chang, Chien-
Chung Chen, Hsiang-Shun Shih, Ting-Mao Chou, Hsing-
Fu Chen, Guan-Ming Feng, and Chih-Hui Yang:
Beneficial Effect of Intense Pulsed Light on the Wound
Healing in Diabetic Rats. Lasers Surg. Med., 52 (6): 530-
536, 2020.
39- Trinh Cao Minh, Do Xuan Hai and Pham Thi Ngoc: Effects
of Intense Pulsed Light on Tissue Vascularity and
Wound Healing: A Study with Mouse Island Skin Flap
Model. Plast. Surg. Int., 2015: 429367, 2015.
40- Odom G.L., Finney W. and Woodhall B.: Cervical disk lesions.
J. Am. Med. Assoc., 166: 23-28. 1958.