Penoplastika i vakuum-terapija u djece s Fournierovom gangrenom penisa
2020
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.
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