Fournier's gangrene is a form of necrotizing fasciitis that rapidly progresses and affects the deep and superficial tissues of the perineal, scrotal, and genital area. The mortality rate of Fournier's gangrene currently sits at 20-50%, usually coming from low socioeconomic backgrounds that could mainly be attributed to delayed management. The cornerstone of treatment for Fournier's gangrene is wide excision of affected tissue, and appropriate anti-microbial therapy. Paraffinomas are very common in the Philippines, although those that develop Fournier’s Gangrene is relatively rare. In this paper, we aim to share a case of 27-year old male who developed Fournier's Gangrene of the penile shaft following injection of hair serum.

This is a case of a 27-year-old male who presented with an infected, necrotic, painful penile shaft. The patient admitted to self-injecting hair serum into his penile shaft 8 days prior to consult, to augment penile girth. He has no known comorbidities. Preoperative laboratory test results were normal. Following administration of intravenous antibiotics, the patient was immediately taken to the operating room for emergency debridement.

For this patient, the authors performed immediate penile debridement and degloving with a bilateral scrotal flap to reconstruct the defect. All fibrotic and nonviable tissue were completely excised up to the level of the Dartos Fascia. Samples for tissue culture and sensitivity were taken. At the end of the procedure, the penile shaft up to its base was completely degloved. There was no scrotal involvement and the scrotal skin was suitable for reconstruction. Two scrotal flaps were elevated on either side of the midline scrotal raphe, with the scrotal artery serving as the pedicle. The flaps were then rotated medially to cover the penile shaft from both directions. Both flaps were sutured along the midline of the ventral aspect of the penile shaft. The scrotal defects were then closed primarily, making sure that there was no undue tension during the closure of the gap. The patient was discharged on the 18th postoperative day. At one-month follow-up, there was good wound healing with viable flaps and scrotal skin.

Fournier's gangrene in the setting of a paraffinoma is a surgical emergency. Prompt management, with wide excision and initiation of antimicrobial therapy should be done. Reconstruction of the defect can be carried out immediately or in a delayed manner depending on the viability of the remaining tissue following debridement. A bilateral scrotal flap is very good option that offers very good cosmetic and functional results, when immediate repair is contemplated.