BACKGROUND: Fournier's gangrene is a rare, rapidly progressive, necrotising fasciitis of the external genitalia and perineum with high morbidity and mortality. PATIENTS & METHODS: 15 patients with Fournier's gangrene were enrolled. Gender, age, aetiology, predisposing factors, symptomatology, associated diseases, hospital stay, FGSI, and body surface area were analysed. RESULTS: Ten males and five females were enrolled in the study. The mean age was 54 years (range 23-81). E. coli and acinetobacter were the common organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. Common predisposing factors included diabetes mellitus (73.3%), poor personal hygiene (60%), obesity (33.3%), psychosis (20%) and decubitus ulcers (13.2%). Whereas five (33.3%) patients developed synergistic gangrene of the scrotum secondary to anorectal disease, five (33.3%) had a urological source of infection. Mean BSA and FSGI scores were 15.93 +/- 3.13 and 6.02 +/- 0.95, respectively. Serum glucose > 140 mg/dl, the existence of septic shock on admission, the spread of gangrene to the perineum and abdominal wall (Groups C and D), BSA > or = 24 cm2, a cutaneous source of infection and FGSI scores > or = 7 were factors affecting mortality rates with statistical significance (p < 0.05). There was a direct correlation between the culture of mixed type micro-organisms and the cutaneous source of infection (p < 0.05). The extent of gangrene correlated with higher FGSI scores (> or = 7) (p < 0.05). Mortality and morbidity rates were as 20% (n = 3) and 60% (n = 9). CONCLUSION: Aggressive surgical debridement and combined antibiotherapy are essential in the management of Fournier's gangrene. FGSI and BSA are useful to assess the severity and prognosis of the disease.
BACKGROUND: Fournier's gangrene is a rare, rapidly progressive, necrotising fasciitis of the external genitalia and perineum with high morbidity and mortality. PATIENTS & METHODS: 15 patients with Fournier's gangrene were enrolled. Gender, age, aetiology, predisposing factors, symptomatology, associated diseases, hospital stay, FGSI, and body surface area were analysed. RESULTS: Ten males and five females were enrolled in the study. The mean age was 54 years (range 23-81). E. coli and acinetobacter were the common organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. Common predisposing factors included diabetes mellitus (73.3%), poor personal hygiene (60%), obesity (33.3%), psychosis (20%) and decubitus ulcers (13.2%). Whereas five (33.3%) patients developed synergistic gangrene of the scrotum secondary to anorectal disease, five (33.3%) had a urological source of infection. Mean BSA and FSGI scores were 15.93 +/- 3.13 and 6.02 +/- 0.95, respectively. Serum glucose > 140 mg/dl, the existence of septic shock on admission, the spread of gangrene to the perineum and abdominal wall (Groups C and D), BSA > or = 24 cm2, a cutaneous source of infection and FGSI scores > or = 7 were factors affecting mortality rates with statistical significance (p < 0.05). There was a direct correlation between the culture of mixed type micro-organisms and the cutaneous source of infection (p < 0.05). The extent of gangrene correlated with higher FGSI scores (> or = 7) (p < 0.05). Mortality and morbidity rates were as 20% (n = 3) and 60% (n = 9). CONCLUSION: Aggressive surgical debridement and combined antibiotherapy are essential in the management of Fournier's gangrene. FGSI and BSA are useful to assess the severity and prognosis of the disease.
Authors: Antonio Tarasconi; Gennaro Perrone; Justin Davies; Raul Coimbra; Ernest Moore; Francesco Azzaroli; Hariscine Abongwa; Belinda De Simone; Gaetano Gallo; Giorgio Rossi; Fikri Abu-Zidan; Vanni Agnoletti; Gianluigi de'Angelis; Nicola de'Angelis; Luca Ansaloni; Gian Luca Baiocchi; Paolo Carcoforo; Marco Ceresoli; Alain Chichom-Mefire; Salomone Di Saverio; Federica Gaiani; Mario Giuffrida; Andreas Hecker; Kenji Inaba; Michael Kelly; Andrew Kirkpatrick; Yoram Kluger; Ari Leppäniemi; Andrey Litvin; Carlos Ordoñez; Vittoria Pattonieri; Andrew Peitzman; Manos Pikoulis; Boris Sakakushev; Massimo Sartelli; Vishal Shelat; Edward Tan; Mario Testini; George Velmahos; Imtiaz Wani; Dieter Weber; Walter Biffl; Federico Coccolini; Fausto Catena Journal: World J Emerg Surg Date: 2021-09-16 Impact factor: 5.469