PERINEAL RECONSTRUCTION AFTER NECROTIZING FASCIITIS

Introduction: Necrotizing fasciitis of the perineum, often referred to as Fournier’s gangrene, is a rare but life-threatening condition requiring aggressive debridement that frequently results in large perineal defects. The reconstruction of these defects poses significant surgical challenges, with multiple techniques available depending on wound size, contamination, and patient comorbidities. Objective: The main objective of this review is to systematically evaluate the available evidence on reconstructive strategies for perineal defects following necrotizing fasciitis. Secondary objectives include assessing functional and aesthetic outcomes, complication rates, quality of life, and the role of multidisciplinary care in optimizing results. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Inclusion criteria comprised studies published within the last 5 years, with possible extension to 10 years if fewer than 10 studies were available. Human studies were prioritized, while animal and in vitro data were analyzed separately. Independent reviewers conducted screening, full-text assessment, and data extraction in accordance with PRISMA. Risk of bias was evaluated using RoB 2, ROBINS-I, and QUADAS-2, and certainty of evidence was assessed with GRADE. Results and Discussion: Out of 1,274 identified studies, 22 met eligibility criteria. Techniques reported included skin grafts, local flaps, regional pedicled flaps, and free tissue transfer. The choice of method was influenced by defect size, contamination level, and patient condition. Evidence suggested that flap-based reconstructions offered superior outcomes in terms of durability and protection of vital structures, while grafting remained a valid option in smaller, clean wounds. Conclusion: Perineal reconstruction after necrotizing fasciitis requires individualized decision-making, guided by defect characteristics, patient comorbidities, and multidisciplinary expertise. Flap techniques provide robust coverage and functional preservation, but simpler methods remain relevant in selected scenarios. Future research should focus on long-term quality of life and standardized outcome measures. Descriptors: Necrotizing Fasciitis, Surgical Flaps, Reconstructive Surgical Procedures, Perineum