Successful perineum and scrotal reconstruction after Fournier gangrene using rotation of a medial thigh fasciocutaneous flap. Report of a case in low-resource settings and literature review

Background: Fournier's gangrene is a form of necrotizing fasciitis involving the perineal and scrotal region. It is characterized by rapid and extensive tissue destruction associated with signs of systemic toxicity. It's a real medical and surgical emergency. The diagnosis is essentially clinical and assisted by imaging in cases of atypical presentation. The urgent medical care associated with extensive surgical debridement helps to reduce the morbidity and mortality of this pathology with devastating consequences. Secondly the treatment will consist of tissue reconstruction when local and general conditions permit. Case Presentation: the authors report the case of a 54-year-old black obese man, who is semi-Bantu ethnic group. He was transported to the emergency department of Douala Laquintinie Hospital (DLH) for painful swelling and offensive smell from bursa and perineal region for 4 days prior to admission. These symptoms were preceded by progressive peri-anal painful swelling unrelated to stool and fever. The diagnosis of Fournier's gangrene following anal abscess was made. The initial care consisted of intensive resuscitation with correction of hydroelectrolytic imbalance, broad spectra antibiotics and analgesics. The patient subsequently underwent major debridement in the operating room. The second stage of management consisted of a cutaneous reconstruction using a rotating fasciocutaneous flap taken bilaterally from each anteromedial aspect of the thighs. Conclusion: Fournier's gangrene is a serious and life-threatening condition. It requires early diagnosis, adequate treatment without delay associating resuscitation measures and extensive debridement in the operating room. The second stage of management consists of tissue reconstruction using skin grafts or fasciocutaneous flaps most often.