Spermatic cord tunnel Penrose drainage for cephalad-tracking Fournier's gangrene: a case report

Fournier's gangrene tracking cephalad along spermatic cords complicates source control and soft tissue reconstruction. We describe a 61-year-old male with poorly controlled diabetes who presented with extensive scrotal necrotizing fasciitis tracking superiorly to the suprapubic region. Following wide excisional debridement, bilateral Penrose drains were passed through the spermatic cord tunnels and brought out through dependent perineal counter incisions. This technique provided effective through-and-through drainage of the cephalad tracts while limiting abdominal tissue loss. Deep wound cultures uniquely grew methicillin-resistant Staphylococcus aureus as a monomicrobial organism. Following serial debridements, a dermal regeneration template was applied to the scrotal and perineal defect, followed by staged split-thickness skin grafting. Complete coverage and structural preservation were achieved without the need for urinary or fecal diversion.