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Penoplastika i vakuum-terapija u djece s Fournierovom gangrenom penisa
Liječnički vjesnik, 142 (2020), 7-8; 239-243. https://doi.org/10.26800/LV-142-7-8-39
Antabak, Anko; Papeš, Dino; Bulić, Krešimir; Leutić, Tomislav; Dobrić, Ivan

Institutional repository: Dr Med - University of Zagreb School of Medicine Digital Repository

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Antabak, A., Papeš, D., Bulić, K., Leutić, T. & Dobrić, I. (2020). Penoplastika i vakuum-terapija u djece s Fournierovom gangrenom penisa. Liječnički vjesnik, 142. (7-8), 239-243. doi: 10.26800/LV-142-7-8-39

Antabak, Anko, et al. "Penoplastika i vakuum-terapija u djece s Fournierovom gangrenom penisa." Liječnički vjesnik, vol. 142, no. 7-8, 2020, pp. 239-243. https://doi.org/10.26800/LV-142-7-8-39

Antabak, Anko, Dino Papeš, Krešimir Bulić, Tomislav Leutić and Ivan Dobrić. "Penoplastika i vakuum-terapija u djece s Fournierovom gangrenom penisa." Liječnički vjesnik 142, no. 7-8 (2020): 239-243. https://doi.org/10.26800/LV-142-7-8-39

Antabak, A., et al. (2020) 'Penoplastika i vakuum-terapija u djece s Fournierovom gangrenom penisa', Liječnički vjesnik, 142(7-8), pp. 239-243. doi: 10.26800/LV-142-7-8-39

Antabak A, Papeš D, Bulić K, Leutić T, Dobrić I. Penoplastika i vakuum-terapija u djece s Fournierovom gangrenom penisa. Liječnički vjesnik [Internet]. 2020 [cited 2024 December 26];142(7-8):239-243. doi: 10.26800/LV-142-7-8-39

A. Antabak, D. Papeš, K. Bulić, T. Leutić and I. Dobrić, "Penoplastika i vakuum-terapija u djece s Fournierovom gangrenom penisa", Liječnički vjesnik, vol. 142, no. 7-8, pp. 239-243, 2020. [Online]. Available at: https://urn.nsk.hr/urn:nbn:hr:105:043778. [Accessed: 26 December 2024]

Metadata
Title (croatian)Penoplastika i vakuum-terapija u djece s Fournierovom gangrenom penisa
Title (english)Penoplasty and vacuum-assisted closure in children with Fournier’s gangrene of the penis
AuthorAnko Antabak
AuthorDino Papeš
AuthorKrešimir Bulić
AuthorTomislav Leutić
AuthorIvan Dobrić
Author's institutionUniversity of Zagreb
School of Medicine
(Department of Surgery)
Scientific / art field,
discipline and subdiscipline		BIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Surgery
Abstract (croatian)
Fournierova gangrena (FG) penisa vrlo rijetko nastaje u djece. Liječenje započne odstranjenjem nekrotičnog tkiva i zaustavljanjem infekcije. Penoplastikom ogoljenog penisa, koja je zahtjevan i komplikacijama opterećen postupak, treba osigurati erektilnu funkciju i estetski prihvatljiv ishod. U radu se prikazuje tehnika penoplastike i primjene vakuum terapije u troje djece s FG penisa. U periodu 2000. do 2017. godine u KBC Zagreb je liječeno troje djece s FG penisa. Gangrena se razvila tijekom snažne imunosupresije zbog kemoterapija akutne limfatične leukemije, koja je krenula kao infekcija kože skrotuma, prepucija i perineuma. Nakon nekrektomije u općoj anesteziji, postavljen je i za glans fiksiran Foley urinarni kateter. Slobodni kožni presadak je uzet s lateralne strane natkoljenice u debljini 0,5 mm. Presadak je postavljan i šavovima fiksiran u nepotpunoj erekciji. Cirkularno punim opsegom obložen je prvo vazelinskom gazom, a preko nje spužvom debljine 20 mm. Preko svega je postavljena adherentna folija i vakuum-cijev. Negativni tlak je održavan aparatom kontinuirano na 75 mm Hg, kako bi penis bio u produženoj erekciji. Praćena je prokrvljenost penisa kontrolom kapilarnog pulsa na eksponiranom glansu. Sustav negativnog vakuum-tlaka (VAC, engl. Vacuum Assisted Closure) odstranjen je sedmog dana. Nije bilo poslijeoperacijskih komplikacija, a puna reepitelizacija trajala je deset dana. Petnaestogodišnji pacijent je godinu dana nakon operacije i izlječenja osnovne bolesti imao bezbolnu erekciju, a masturbacijom je postigao ejakulaciju. Kako bi se minimalizirala mogućnost naknadne kontrakcije, korišteni su nešto deblji presadci. Negativni tlak od 75 mm Hg sustavno je čitavim obujmom fiksirao presadak kože unatoč konveksitetu podloge. Druga mu je funkcija održavati kavernozna tijela penisa u nepotpunoj erekciji, kako bi se slobodni kožni presadak fiksirao punom površinom. Neki su autori koristili sličnu tehniku, s jačim negativnim tlakom, no oni bilježe značajnu razinu poslijeoperacijske boli. Izostanak komplikacija, uz zadovoljavajući estetski, ali i funkcionalni ishod, ovu metodu penoplastike i vakuum-terapije promovira kao metodu izbora u djece s Fournierovom gangrenom penisa.
Abstract (english)
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.
Keywords (croatian)
Keywords (english)
Languagecroatian
Publication typeProfessional paper - Other
Publication statusPublished
Peer reviewPeer review
Publication versionPublished version
Journal titleLiječnički vjesnik
Numberingvol. 142, no. 7-8, pp. 239-243
p-ISSN0024-3477
e-ISSN1849-2177
DOIhttps://doi.org/10.26800/LV-142-7-8-39
URN:NBNurn:nbn:hr:105:043778
Publication2020
Document URLhttps://hrcak.srce.hr/index.php?show=clanak&id_clanak_jezik=353586
Type of resourceText
Access conditionsOpen access
Terms of useLicence Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) icon
Created on2020-11-26 09:11:51