Fournier Gangrene: A Review for Emergency Clinicians

Montrief, Tim; Long, Brit; Koyfman, Alex; Auerbach, Jonathan

doi:10.1016/j.jemermed.2019.06.023

Cited by 56 publications

(94 citation statements)

References 103 publications

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“…NSTI may be polymicrobial or monomicrobial in nature [1,2,14]. The infection moves through the deeper layers of the soft tissues, along the fascial planes, hence given the name of necrotizing fasciitis, a vigorous immune response subsequently occurs with extensive neutrophil rich inflammation [15]. An ensuing angio-thrombotic microbial invasion of fascia and obliterative endarteritis progresses to cause necrosis of the dermal and subcutaneous tissues [5,13,[16][17].…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes mellitus is a risk factor in up to 70% of all NSTI patients, including the Fournier's gangrene subtype [2,4,5,8,9,[11][12][13][14][15][16][17][18]. Additional commonly described risk factors include increasing age, chronic liver disease, chronic kidney disease, obesity, immunosuppression, underlying malignancy, and poor hygiene [5,10,12,16].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

Peters¹,

Iacobelli²,

Ryan³

2020

Cureus

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

Peters¹,

Iacobelli²,

Ryan³

2020

Cureus

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“…The ASA score was I [0 patients], II [2], III [5], IV [8], V [1], ASA score was unreported in six of the patients managed only with local anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…1 The related mortality arises from 3 to 45 per cent with an overall rate of 16 per cent proposed by a recent review. 2 Deaths are due to severe sepsis, coagulopathy, acute renal failure, diabetic ketoacidosis and multiple organ failure.…”

Section: Introductionmentioning

confidence: 99%

Which Role for Hyperbaric Oxygen Therapy in the treatment of Fournier’s gangrene? A Retrospective Study.

Tutino

Colli

Rizzo

et al. 2020

Preprint

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Background: In Fournier’s gangrene the surgical debridement plus broad-spectrum antimicrobial therapy is the mainstay treatment but can cause a great loss of tissue. Moreover, the local poor blood supply, the infection and the damage to the vessels can delay the healing. Consequently, the disease needs long hospital stays and, despite all, has high mortality rate. The aim of our study is to investigate the improvement offered by hyperbaric therapy in Fournier’s gangrene.Methods: We retrospectively evaluated data on 23 consecutive patients admitted for Fournier’s gangrene at the University hospital “P.Giaccone” of Palermo from 2011 to 2018. The relation between hyperbaric therapy, hospital stay and mortality was evaluated. Factors related to mortality were also examined.Results: The use of hyperbaric therapy was offered to 13(56.5%) patients. Hospital stay was longer in patients treated with HBOT[mean11(C.I.0.50-21,89)vs25(C.I.18.02-31.97);p=0.02]. Mortality occurred in three patients(13.1%), two of whom treated with HBOT. Mortality was not statistically related to sex(p=0.20), BMI(p=0.53), renal failure (p=1.00), diabetes(p=0.49), age>65 years old(p=0.55), simplified FGSI>2(p=0.05), higher ASA scores(>=4)(p=0.47), symptoms at admission lasting since more than 72 hours (p=0.28), HBOT(p=1.00), need of colostomy(p=0.06), several operations(p=1.00), several operations plus HBOT(P=1.00). Conversely, the delay between admission and surgical operation was statistically related to mortality, 1.7 days(C.I.0.9-3.5) in survivals vs 6.8 days(C.I.3.5-13.4) in death patients(p=0.001).Conclusions: Our study proves that a delay in the treatment of patients with Fournier’s gangrene has a correlation with the mortality rate, while the use of HBOT seems to not improve the survival rate, increasing the hospital stay instead.

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“…These examination findings mimic milder soft tissue infections such as cellulitis, impetigo, and erysipelas, though these infections typically have clearly demarcated borders versus the patchy erythema and erratic bulla formation of FG. 12,59 Abrasions and fluctuance of the genitalia and perineum should raise suspicion for FG. 17 Skin changes including crepitation upon palpation of affected tissues, bronzing, purpura, bulla formation, and patchy anthracosis indicate disease progression.…”

mentioning

confidence: 99%

<p>Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives</p>

Auerbach¹,

Bornstein²,

Ramzy³

et al. 2020

OAEM

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Fournier gangrene (FG) is a rare and life-threatening urosurgical emergency characterized most often by a polymicrobial infection of the perineal, genital, or perianal region. FG has an increased incidence in male patients, patients with alcoholism, and patients with immunocompromise including human immunodeficiency virus (HIV) and uncontrolled diabetes. FG often begins as a simple abscess or cellulitis with progression to necrotizing soft tissue infection (NSTI). Delays in diagnosis and treatment confer high mortality. Early recognition and high clinical suspicion are important in making a timely diagnosis, as early manifestations are often subtle. The most significant modifiable risk factor associated with NSTI mortality is delay to surgical intervention. Coordination of both inpatient medical and surgical teams to implement appropriate therapy is vital to successful outcomes. The emergency medicine clinician must be vigilant for this condition and be aware of risk factors, prognostic indicators, and proper treatment protocols to recognize FG early and initiate appropriate management. The objective of this review is to provide updated and relevant information regarding recognition, diagnosis, and management of FG for the emergency medicine provider.

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Fournier Gangrene: A Review for Emergency Clinicians

Cited by 56 publications

References 103 publications

Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

Which Role for Hyperbaric Oxygen Therapy in the treatment of Fournier’s gangrene? A Retrospective Study.

<p>Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives</p>

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