Penoplasty and vacuum-assisted closure in children with Fournier’s gangrene of the penis
Anko Antabak, Dino Papeš, Krešimir Bulić, Tomislav Luetić, Ivan Dobrić
Fournier’s gangrene (FG) of the penis rarely occurs in boys. Initial treatment consists of debridement and infection control. Penoplasty, a complex procedure burdened with complications, should ensure good erectile function and aesthetic outcome. This article presents the vacuum-assisted penoplasty procedure that was undertaken in three children with FG of the penis from 2000 to 2017 in University Hospital Centre Zagreb. FG started at the prepuce, penile skin or scrotum due to immunosuppression caused by chemotherapy for acute lymphatic leukaemia. Necrectomy of the whole penile shaft was performed in general anaesthesia, and urinary catheter was placed and fixated to the glans. A partial thickness skin graft (0.5 6 mm) was harvested from the lateral thigh, placed on the penile shaft while artificial erection was maintained (to ensure sufficient skin for later erections) and fixated with quilting sutures. The skin graft was covered by Vaseline gauzeVaseline® Petrolatum gauze, circular 20 mm thick VAC (Vacuum Assisted Closure ) sponge and adhesive film. Negative pressure was maintained at 75 mm Hg and the penis was kept in erected state. Glans capillary refill was regularly checked. Vacuum therapy was removed on the seventh postoperative day. There were no postoperative complications and full re-epithelisation occurred on postoperative day 10. The 15-year-old patient reported painless postoperative erections and achieved ejaculation with masturbation. Thicker than usual grafts were used to minimize graft contraction. Negative pressure of 75 mm Hg and complete adherence of the sponge were achieved despite the cylindrical shape of the wound bed. The function of the vacuum system was not only to fixate the graft, but to maintain the penile shaft in the state of permanent artificial erection. The pressure of 75 mm Hg was chosen because the reports in which higher pressures were used reported a higher postoperative pain levels as well. Good functional and aesthetic outcome with no complications make this procedure the method of choice for the reconstruction of penile shaft skin defects after Fournier’s gangrene in children.