Case Report New Methods of Reconstruction for Old Challenges: The Use of the Integra Graft in Necrotizing Soft Tissue Infections of the Male Genitalia Katharina Mitchell , 1 Chad Crigger , 1 Chad Morley , 1 John Barnard , 1 and Vidas Dumasius 2 1 West Virginia University Department of Urology, USA 2 Marietta Memorial Hospital Department of Cosmetic, Plastic and Reconstructive Surgery, USA Correspondence should be addressed to Katharina Mitchell; kmm0051@mix.wvu.edu Received 14 June 2021; Revised 4 August 2021; Accepted 25 September 2021; Published 7 October 2021 Academic Editor: Apul Goel Copyright © 2021 Katharina Mitchell et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In this paper, we describe two cases of Fournier’s gangrene (FG) in which Integra grafting was used for reconstruction. FG is a progressive necrotizing infection occurring in the perineal region and on the external genitalia. Reconstructive options using local tissue are limited due to the destruction this infection imposes on the soft tissue. Integra graft is a bilaminate artificial dermis made of shark chondroitin 6-sulfate and bovine collagen. It is applied to the wound bed after debridement and establishment of a healthy, well-vascularized wound base. The patients in this case series had large defects which could not be closed primarily with tissue beds and would not have been appropriate for skin grafting. Therefore, an Integra graft was placed. In both patients, the wound beds were appropriate for skin grafting after three weeks. Without the Integra graft, both of our patients would have needed to wait a considerable amount of time prior to reconstruction. Our case series further illustrates and supports the use of Integra grafts in such a scenario following Fournier’s gangrene which has only previously been published on three occasions, all of which demonstrated successful outcomes. 1. Introduction Fournier’s gangrene (FG), often also referred to as necrotiz- ing fasciitis, is a progressive necrotizing infection occurring in the perineal region and on the external genitalia [1]. The underlying pathology of FG is an obliterative endarter- itis of the subcutaneous arteries which leads to ischemia, destruction, and subsequent gangrene of the overlying skin and subcutaneous tissues. It is a rare, but highly lethal, pro- cess due to severe multiple organ failure. The incidence is more common in men, persons over 50 years, those with diabetes mellitus, long-term alcoholics, and people with malignant neoplasms [1, 2]. Often the nidus for this synergistic polymicrobial infec- tion is found in the genitourinary tract, lower gastrointesti- nal tract, and/or skin [1]. Though often polymicrobial, Proteus mirabilis has been found to be the predominant pathogen [3]. Standard of care in treating this disease process begins with rapid and aggressive surgical debridement of necrotic tissue, hemodynamic support, and broad-spectrum parental antibiotics. Following radical debridement, sterile dressings and negative pressure wound therapy (wound vacuum devices) are typically used to treat open wounds [1]. Reconstructive options using local tissue are limited due to the destruction this infection imposes on the soft tissue, which is often too inflamed or lacking altogether due to the extensive surgical debridement required. These factors limit reconstructive options based on local tissue transfers or utilization of adjacent fasciocutaneous flaps. Tissue flaps in turn can also be problematic—either too bulky or insuffi- cient coverage if skin grafting alone is utilized [3]. A new use for existing technologies may fill the void. The Integra graft Hindawi Case Reports in Urology Volume 2021, Article ID 5777235, 5 pages https://doi.org/10.1155/2021/5777235