The role of hyperbaric oxygen therapy in Fournier’s Gangrene: A systematic review and meta-analysis of observational studies

Raizandha, Muhammad Achdiar; Hidayatullah, Furqan; Kloping, Yudhistira Pradnyan; Rahman, Ilham Akbar; Djatisoesanto, Wahjoe; Rizaldi, Fikri

doi:10.1590/s1677-5538.ibju.2022.0119

Cited by 6 publications

(2 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Raizandha et al 49 demonstrated a significant reduction in mortality in patients of FG receiving HBOT but noted no reduction in the number of debridements and the mean length of hospital stay.…”

Section: Adjuvant Treatmentsmentioning

confidence: 99%

A contemporaneous narrative review of Fournier’s gangrene

Desai

Batura

2023

Urologia

View full text Add to dashboard Cite

Introduction: Fournier’s gangrene is a necrotizing infection of the external genitalia, perineal or perianal regions and is mainly seen in males. Its main risk factors include diabetes, chronic alcoholism, HIV and other immune-compromised states. Fournier’s gangrene has an aggressive course associated with a mortality rate of 20%−30%, making early diagnosis and management very important. The Fournier Gangrene Severity Index (FGSI) has been traditionally used to predict the severity and prognosis. More recently, simplified FGSI (sFGSI) has been proposed and is helpful. However, timely diagnosis, supportive medical management and complete surgical debridement are still the cornerstones of treatment. These must be complemented with early and timely re-look debridements and appropriate reconstruction to cover soft tissue defects. This literature review aims to look at recent relevant research regards risk factors and prognostic features of Fournier’s gangrene. Methods: A search was conducted on Google Scholar and PubMed databases for all articles related to Fournier’s Gangrene. These included clinical reviews, case reports, case series and retrospective studies. Reports or studies which were not published in English were not reviewed. Various reconstructive techniques to cover the defects have also been revisited. Results: Broad-spectrum antibiotics and urgent surgical debridement are the core management principles of Fournier’s gangrene. Repeat debridement after 24 h is also recommended. Adjunctive therapies such as hyperbaric oxygen and vacuum-assisted closure are supported in most aspects of recent literature. Expectedly, there is a lack of randomised controlled studies in such emergency surgical conditions, which limits the widespread use of newer therapies to patients unresponsive to conventional management. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate. The aggressive nature of the infection necessitates early recognition and immediate surgical intervention. Negative pressure dressing and occasional hyperbaric oxygen as adjuncts should be used more routinely, especially if there is a delayed response to conventional treatment or in severe infections.

show abstract

Section: Adjuvant Treatmentsmentioning

confidence: 99%

A contemporaneous narrative review of Fournier’s gangrene

Desai

Batura

2023

Urologia

View full text Add to dashboard Cite

show abstract

“…To date, the clinical management of FG consists of extensive surgical debridement, fascia incision, the drainage of necrotic tissue, and sufficient intravenous administration of broad-spectrum antibiotics [ 3 ]. Moreover, recent studies have also highlighted the potential benefits of hyperbaric oxygen therapy [ 4 ]; however, its application is still limited, due to challenges in accessing and transferring patients to units that offer this service.…”

Section: Introductionmentioning

confidence: 99%

The Value of Fournier’s Gangrene Scoring Systems on Admission to Predict Mortality: A Systematic Review and Meta-Analysis

Tufano,

Dipinto,

Passaro

et al. 2023

JPM

View full text Add to dashboard Cite

Objective: To systematically review and meta-analyze the predictive value of the Fournier gangrene severity index (FGSI), the simplified FGSI (SFGSI), and the Uludag FGSI (UFGSI) on mortality in patients affected by Fournier’s Gangrene (FG). Methods: A search was performed in PubMed, Web of Science, Embase, and the Cochrane Library, from January 2000 to May 2023, to identify original cohorts comparing data between surviving and non-surviving FG patients. The statistical analysis consisted of two parts. First, the mean and standard deviation (SD) of the FGSI, SFGSI, and UFGSI at admission were extrapolated from each study, and the pooled mean difference (MD) with 95% confidence interval (95% CI) was obtained using the Der Simonian–Laird random-effect model. Second, to evaluate the accuracy of the FGSI, SFGSI, and UFSGI in predicting mortality, true positive (TP), false positive (FP), true negative (TN), and false negative (FN) values were extracted where possible and reported in 2 × 2 contingency tables. The sensitivity, specificity, and AUC values were pooled, and summary receiver operating characteristic (SROC) curves were constructed. Results: Overall, forty studies comprising 2257 patients were included. The pooled analysis revealed that the FGSI, SFGSI, and UFGSI values at admission were higher in non-survivors than survivors (MD: 5.53 (95% CI: 4.68–6.37); MD: 2.41 (95% CI: 1.06–3.77); and MD: 5.47 (95% CI: 3.68–7.26), respectively). Moreover, the AUC values of the FGSI, SFGSI, and UFGSI were 0.90 (95% CI: 0.87–0.92), 0.84 (95% CI: 0.80–0.87), and 0.94 (95% CI: 0.92–0.96), respectively. Conclusions: The higher scores of the FGSI, SFGSI, and UFGSI on admission were associated with mortality. Moreover, when comparing accuracy rates, the UFGSI exhibited the highest AUC value.

show abstract