The management of Fournier’s gangrene: A review of 60 patients

2016-02-21T19-08-33Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Salih Onur Basat, Tumay Ipekci, Fatih Ceran, Mehmet Kisaarslan, Mehmet Bozkurt.
Background: Fourniers gangrene (FG) is a rapidly progressive, destructive, necrotizing fasciitis of perianal, perineal,and genital region. The common clinical symptoms include sudden intense pain in the scrotum, prostration,fever, and pallor. In this study, it was aimed to assess FG in a wider angle. Methods: 60 patients with the mean age of 55 (ranged between 48-62) that presented with FG in our hospital over a 6 year period between April 2008 and March 2014 were retrospectively reviewed. Age, gender, site of gangrene, risk factors, symptoms, microbiology, treatment modalities, FGSI score, and mortality datas were evaluated. Results: 60 male patients with the mean age of 55 (ranged between 48-62) were included to the study. 50 patients survived, mortality rate was 16.6%. Septic shock (n: 4), cardiogenic shock (n:4) and pneumonia (n:2) were causes of death. As a risk factor, 45 (75%) patients had DM, 40 (66.6%) patients had HT, and 35 (58.3%) patients had both DM and HT. There were no other co-morbid situation for 10 (16.6%) patients. All the survived 50 patients were suitable for surgical reconstruction. STSG procedure was performed for 46 (76.6%) patients and flap reconstruction was performed for 4 (6.6%) patients. None of the patients had hyperbaric oxygen therapy (HBO). Length of hospitalization was 16 days (5-58) for all patients. A mean FGSI score at admission was of 5.02 ± 2.45 for survivors compared with 13.8 ± 4.53 for non-survivors. A mean FGSI score was of 4.56 ± 2.28 for survivors and 11.50 ± 2.63 in non-survivors during hospitalization. Conclusion: Although FG has high mortality rates, appropriate management of the disease can reduce rates. Early diagnosis, surgical debridement, VAC application and antibiotherapy are the essentials for FG.


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