Novel application of fish skin graft for wound bed preparation in scrotal reconstruction surgery after Fournier gangrene infection: case study

Introduction: Fournier's gangrene is an infection of the genitals and perineum that often needs extensive soft tissue debridement, often leading to loss of scrotal skin. After full debridement coverage is needed for the testicles; traditionally the method of treatment has been placement of the testes in subcutaneous pockets in the thighs, the use of local flaps or even a free flap. The aim of the reconstruction is a good cosmetic and functional outcome.

In this case study we are evaluating the feasibility of using fish skin graft with split thickness skin graft.

Methods: A 45-year-old male presents with Fournier gangrene infection of the scrotum as complication of sterilization surgery performed 3 weeks earlier. Due to the acute septic status of the patient; he was directly taken into surgery for excision of the necrotic scrotum wall. The testicle wall was completely removed. The testicles were temporarily left in a subcutaneous pocket in the upper thighs.The decision was made to cover the testicles fish skin graft two weeks after initial excision. At 16 days after application of the fish skin graft, the patient was grafted with split thickness skin with adjunct treatment of light pressure garments.

Results: The fish skin graft allowed for good coverage and granulation tissue preparing the area for split-thickness graft. The split thickness skin graft had 100 percent take. There were no complications associated with follow-up. The patient does not report any pain or tightness in the area. He is living a normal (sex) life.

Discussion: The reconstruction of the scrotum can be difficult due to the delicate skin in the area. There are different approaches to scrotal reconstruction that may be tried including skin grafts directly on the testicles, local and free flaps. The result of the healing was softer and more pliable then when fish skin graft was not used as a base for a procedure. The fish skin graft helped facilitate functional recovery in patient with a good cosmetic outcome.