Fournier s Gangrene in a Male to Female Transsexual

A. Lee

A 41-year-old non-insulin dependent diabetic male to female transsexual, who had genital reassignment 11 years previously, presented to gynaecologists with a large right labial abscess. The abscess was managed with simple incision and drainage with an excision of a 35mm by 10mm ellipse of skin overlying the abscess cavity. Histology of the excised tissue showed subcorneal bulla and extensive necrosis of fascia and muscle, consistent with necrotising fasciitis. Bacteriology culture grew mixed aerobic and anaerobic streptococci and coliforms. The patient was commenced on appropriate intravenous antibiotics.Postoperative recovery was complicated by an inferior wall myocardial infarction and subsequent complete heart block requiring temporary pacing and inotropic support in coronary care unit for 24 hours.Despite intravenous antibiotic therapy, progressive deterioration of the infection was evident with systemic sepsis and renal impairment. On day four, a radical debridement was performed removing a bridge shaped piece of skin measuring 120mm by 135mm with 60mm of underlying fat. Post-operative recovery was uneventful, and the patient was transferred to the regional plastic surgical centre for reconstruction on day nine.