DELAYED PRIMARY CLOSURE IN ADVANCED FOURNIER’S GANGRENE: A CASE REPORT
14th INTERNATIONAL MODERN SCIENCES CONGRESS September 8-11, 2026 / Ho Chi Min, VIETNAM , Thanh-Pho-Ho-Chi-Minh, Vietnam, 8 Eylül - 11 Ekim 2026, sa.14, ss.267-273, (Tam Metin Bildiri)
- Yayın Türü: Bildiri / Tam Metin Bildiri
- Basıldığı Şehir: Thanh-Pho-Ho-Chi-Minh
- Basıldığı Ülke: Vietnam
- Sayfa Sayıları: ss.267-273
- Yozgat Bozok Üniversitesi Adresli: Evet
Özet
ABSTRACT Fournier’s gangrene (FG) is a rapidly progressive and potentially life-threatening necrotizing soft tissue infection involving the perineal and genital regions. Early diagnosis, prompt surgical debridement, appropriate broad-spectrum antibiotic therapy, metabolic stabilization, and multidisciplinary management are essential to reduce morbidity and mortality. Reconstruction of extensive tissue defects remains challenging, and preservation of viable tissue during debridement may facilitate subsequent wound closure and improve functional and cosmetic outcomes. We present the case of a 68-year-old male patient with poorly controlled diabetes mellitus who was admitted with advanced Fournier’s gangrene involving the right hemiscrotum and perineal region. The patient had multiple comorbidities, including hypertension, hyperlipidemia, coronary artery disease, and a previous cerebrovascular accident. Physical examination revealed marked scrotal edema, skin necrosis, ulceration, perineal swelling, and subcutaneous crepitus. Laboratory evaluation demonstrated severe hyperglycemia and markedly elevated inflammatory markers. The Fournier Gangrene Severity Index score was 5. Scrotal magnetic resonance imaging revealed a heterogeneous paratesticular abscess with extensive inflammatory changes. Emergency surgical exploration and aggressive debridement were performed. Because the right testis was completely involved by the infectious process and no viable testicular tissue remained, right orchiectomy was performed. Necrotic and infected tissues were removed while preserving all viable surrounding scrotal skin. Following culture-directed antibiotic therapy, strict glycemic control, serial wound care, and daily clinical monitoring, adequate infection control and healthy granulation tissue formation were achieved. On postoperative day 7, the remaining viable scrotal skin was mobilized and the defect was successfully repaired by delayed primary closure without the need for complex reconstructive procedures. At one-year follow-up, the patient demonstrated complete wound healing without recurrence, minimal functional impairment, and satisfactory cosmetic outcome. This case highlights the importance of early aggressive treatment combined with tissue-preserving debridement and appropriately timed delayed primary closure in selected patients with advanced Fournier’s gangrene. Keywords: Fournier’s gangrene; necrotizing fasciitis; scrotal reconstruction; delayed primary closure; orchiectomy; debridement