990 Flap Coverage for Fournier’s Gangrene
Bibliographic record
Abstract
Abstract Introduction Fournier’s gangrene (FG) is a life-threatening necrotizing soft tissue infection (NSTI) affecting the perineum and genital region, necessitating urgent debridement and ultimately coverage, often in the burn center context. Skin grafts are often used for reconstruction but may result in suboptimal outcomes. Flap-based reconstructions have shown potential for better functional and aesthetic results, but no systematic review has been undertaken to date. Methods This systematic review was conducted following the PRISMA protocol. A comprehensive search of EMBASE, MEDLINE, Cochrane, Google Scholar, and CINAHL databases was performed. The search terms included “Necrotizing soft tissue infections,” “Gas gangrene,” “Fournier’s gangrene,” “Flap,” and “Graft.” Covidence software facilitated study selection and reference tracking. The inclusion criteria targeted studies on human subjects involving flap reconstruction for NSTI defects of the perineum, while exclusion criteria eliminated studies referred to graft reconstruction, trauma and oncology defects. All study designs were included. A charting form was developed to categorize studies by variables such as study type, flap type, pathology, and defect location. Results After removal of duplicates, the title and abstract of 3760 studies were assessed and 522 studies underwent full-text review. Of the 99 studies included in the qualitative synthesis and data extraction, 31% (n=31) were retrospective and 56% (n=55) were case reports/series. Of the 395 cases described, 501 flaps used 59 distinct techniques, with the anterolateral thigh, medial thigh, and pudendal thigh flaps the most common. Only 2 free flaps were performed. Gracilis was the most frequent locoregional option; others included the anterolateral thigh, medial circumflex femoral perforator, internal pudendal artery perforator, and groin flaps. Complication rates were relatively low, with only 10 partial and 6 total flap losses reported. The majority of studies were published in plastic surgery journals, followed by urology journals; only one appeared in a burn journal. Notably, 58 studies (59%) were published within the last decade. Conclusions After debridement, the aim of FG management is to obtain durable coverage, with a view to minimize disability and optimize appearance. Although skin grafting often fulfils this role, techniques higher on the reconstructive ladder, including local, regional and free flaps, are sometimes required. This systematic review demonstrates that flap-based reconstruction is a reliable method for managing Fournier’s gangrene defects. Applicability of Research to Practice NSTI is commonly and effectively managed in the burn center setting. This systematic review highlights the important contribution of the plastic surgeon as part of multidisciplinary teams managing complex defects resulting from Fournier’s Gangrene. Funding for the Study N/A
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.014 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".