Fournier’s gangrene: a retrospective review of management outcomes and seasonal variations of clinical presentation

Abstract

Background To review retrospectively the outcomes of management of Fournier’s gangrene (FG) and to assess for possible seasonal variations in clinical presentations of FG to a referral hospital in a tropical African country. Methods The medical records of patients who presented with FG from February 2012 to December 2019 were reviewed. Of interest were age of patient, vital signs at presentation, site of gangrene, duration of hospital admission, and management interventions deployed. Analysis was with SPSS® version 21. Results Twenty-three of 28 medical records could be analyzed. Median Fournier’s Gangrene Severity Index (FGSI) was 5 (IQR:3–10), the median Uludag-FGSI (UFGSI) was 7 (IQR:4–14). In 82.6%, the scrotum was the site of onset; in 8.7%, the lesion had spread beyond the pelvis. Diabetes mellitus (30.4%), HIV infection (13.0%) and nephropathy (17.4%) were identified co-morbidities. There were 2.4 ± 1.0 debridement sessions and 1.5 ± 1.3 transfused units of blood per patient. In 60.9%, the wound edges were undermined and apposed; in 17.4%, split skin grafting or fascio-cutaneous flap cover was deployed. In 17.4%, satisfactory wound closure needed more than 1 theater session. Mean duration of hospital admission was 51.4 ± 19.4 days. No mortality was recorded. Majority (91.2%) presented in hot, dry months of October through March with peak in December. No case presented in the wet months of May through September. Conclusion Meager resources notwithstanding, FG management outcomes are generally satisfactory. Furthermore, FG is observed to present mostly in the hot, dry months of the year in the 8 years under review.

Prevalence, Pattern and Early Treatment Outcomes Predictors of Patients with Fournier's Gangrene at University of Dodoma Affiliated Teaching Hospitals

“…Also, concerning clinical presentation of the patients with FG, the common presentations were foul smelling (85.1%), scrotal swelling (80.6%), scrotal pain (56.3%) and the least presentation being penile septic wound 7.5% and penile swelling (3%). This findings was not far from the study done in northern Tanzania and other countries including Nigeria, Kenya Ethiopia which found that the presentations include scrotal/penile pain, fever, scrotal/penile swelling and discharge [19,[21][22][23][26][27][28][29][30][31][32]. Studies reported the most common sites affected to be scrotum and or penis (89.3%), perineum and abdomen [3,[17][18][19].…”

Medial thigh fasciocutaneous flaps for reconstruction of the scrotum following Fournier gangrene: A case report

“…Hyperbaric oxygen, vacuum aspiration, and fecal and urinary diversions techniques are others therapeutics modality that help accelerate the healing process 5,7 . Often, more than one theater session are required for satisfactory results 10 …”

“…The surgical trauma is also out of proportion to the area to be rebuilt. 5 , 7 , 8 , 9 , 10 Barham et al propose the use of the Integra TM dermal regeneration template with good results. However, it is cost prohibitive in our context where the population is poor and health insurance is nonexistent.…”

“…5,7 Often, more than one theater session are required for satisfactory results. 10 Various reconstructive techniques are utilized by different surgeons. This technique includes testis transplantation, free skin graft, axial groin flaps, and myocutaneous flaps.…”

“…Some authors propose using a pedicled musculocutaneous flap, which provides repair tissue that is too thick and useless for the area to be repaired. The surgical trauma is also out of proportion to the area to be rebuilt 5,7,8,9,10 . Barham et al propose the use of the Integra TM dermal regeneration template with good results.…”