Jakub Kuchinka1, Jarosław Matykiewicz2, Iwona Wawrzycka3, Marta Kot4, Włodzimierz Karcz5, Stanisław Głuszek2. 1. Klinika Chirurgii Ogólnej, Onkologicznej i Endokrynologicznej, Wojewódzki Szpital Zespolony w Kielcach. 2. Klinika Chirurgii Ogólnej, Onkologicznej i Endokrynologicznej, Wojewódzki Szpital Zespolony w Kielcach; Wydział Lekarski i Nauk o Zdrowiu, Uniwersytet Jana Kochanowskiego w Kielcach, Zakład Chirurgii i Pielęgniarstwa Chirurgicznego z Pracownią. 3. Klinika Chirurgii Ogólnej, Onkologicznej i Endokrynologicznej, Wojewódzki Szpital Zespolony w Kielcach; Wydział Lekarski i Nauk o Zdrowiu, Uniwersytet Jana Kochanowskiego w Kielcach, Zakład Chirurgii i Pielęgniarstwa Chirurgicznego z Pracownią Genetyki. 4. Wydział Lekarski i Nauk o Zdrowiu, Uniwersytet Jana Kochanowskiego w Kielcach, Zakład Chirurgii i Pielęgniarstwa Chirurgicznego z Pracownią Badań Naukowych i Pracownią Genetyki. 5. Oddział Chirurgii Ogólnej i Onkologicznej Wojewódzkiego Szpitala im. Św. Rafała w Czerwonej Górze.
Abstract
INTRODUCTION: Fournier gangrene (FG) is life - threatening condition, defined as the necrotizing fascitis of perineum and can spread to the adjacent areas. It is rare disease and infection is caused by mixed bacterial flora, seldom by fungal infection. Risk factors are: male sex, diabetes, hypertension, malignant neoplasms, alcoholism, immunospression. MATERIAL AND METHODS: The analysis of four group patients treateted for Fournier gangrene was made about diagnostic and therapeutic process, assessment of prognosis based on Fournier's Gangrene Severity Index). RESULTS: All patients were males. Average age at the moment of diagnosis was 60 years. All of them had comorbidities resulting with the higher risk of susceptibility to FG. Morbitity was 50%, despite of all of patients had less than 9 points in FGSI. DISCUSSION: The FG, despite of better diagnostic tools and technological progres remaines the significant clinical issue because of the mortality - 80%. "The golden standard" is surgical excision of necrotic tissues, antibiotics support, equation of fluid, electrolytes and base - acid balance, level of glycemia is very important. The treating results were assessed on the base of FGSI. The significance has the moment of performing the surgical intervention - it is proven, that should be carried out during 24 hours. The hyperbaric oxygen therapy is controversial. Seem to be appropriate if the infection is caused by anaerobic bacteria. CONCLUSIONS: Fournier syndrome is significant clinical issue. Its treatment requires early surgical approach with exicision of necrotic tissues, antibiotics support and treatment of hyperbaric oxygen in some cases.
INTRODUCTION: Fournier gangrene (FG) is life - threatening condition, defined as the necrotizing fascitis of perineum and can spread to the adjacent areas. It is rare disease and infection is caused by mixed bacterial flora, seldom by fungal infection. Risk factors are: male sex, diabetes, hypertension, malignant neoplasms, alcoholism, immunospression. MATERIAL AND METHODS: The analysis of four group patients treateted for Fournier gangrene was made about diagnostic and therapeutic process, assessment of prognosis based on Fournier's Gangrene Severity Index). RESULTS: All patients were males. Average age at the moment of diagnosis was 60 years. All of them had comorbidities resulting with the higher risk of susceptibility to FG. Morbitity was 50%, despite of all of patients had less than 9 points in FGSI. DISCUSSION: The FG, despite of better diagnostic tools and technological progres remaines the significant clinical issue because of the mortality - 80%. "The golden standard" is surgical excision of necrotic tissues, antibiotics support, equation of fluid, electrolytes and base - acid balance, level of glycemia is very important. The treating results were assessed on the base of FGSI. The significance has the moment of performing the surgical intervention - it is proven, that should be carried out during 24 hours. The hyperbaric oxygen therapy is controversial. Seem to be appropriate if the infection is caused by anaerobic bacteria. CONCLUSIONS: Fournier syndrome is significant clinical issue. Its treatment requires early surgical approach with exicision of necrotic tissues, antibiotics support and treatment of hyperbaric oxygen in some cases.
Entities:
Keywords:
Fourniere gangrene; early surgical approach ; hyperbaric oxygen treatment