AB187. SOH26AB_0343. Fournier’s gangrene: video-based surgical assessment, debridement, and early reconstruction

Abstract: Fournier’s gangrene is a rapidly progressive necrotising infection of the perineum requiring urgent recognition and aggressive surgical management. This video abstract, supported by sequential clinical images, presents the complete management of a severe case treated within a tertiary urological service. It represents the first instance in the Department of Urology at University Hospital Limerick, in which definitive reconstruction was completed during the index admission. The material is designed to highlight key decision-making steps, operative techniques, and practical considerations for educational purposes, particularly for trainee surgeons. A patient presented with fulminant perineal sepsis and underwent immediate resuscitation, broad-spectrum antimicrobial therapy, and urgent operative debridement. Serial re-debridements were performed in accordance with departmental protocol to ensure complete removal of necrotic tissue. Wound management included the application of negative pressure wound therapy to maintain a clean wound bed and promote granulation. Once infection control was achieved, semi-elective reconstruction was performed using a split-thickness skin graft harvested with a dermatome. The submitted video demonstrates the initial assessment, the principles of surgical debridement, perioperative wound management, and a step-by-step summary of the reconstructive technique. The patient achieved full graft take with no postoperative complications, demonstrating excellent functional and cosmetic outcomes. The accompanying video and images provide a comprehensive educational guide to the staged management of Fournier’s gangrene within a urological surgical service. This case underscores the feasibility and benefits of definitive same-admission reconstruction in selected patients. The video abstract serves as a practical educational resource outlining key assessment and surgical steps for trainees and surgeons managing Fournier’s gangrene.

Keywords: Fournier’s gangrene; urological surgery; surgical debridement; negative pressure wound therapy; split-thickness skin graft