Fournier's Gangrene: A Summary of 10 Years of Clinical Experience

Abstract

We aimed to present our clinical experience with FG treatment. Fournier's gangrene (FG) is a rare but serious disease characterized by progressive necrosis in the genitourinary and perineal region. The retrospective study included 43 patients. Patients were divided into 2 groups as survivors and nonsurvivors. Included in the analysis were data pertaining to demographics, predisposing factors, comorbidities, results of bacteriologic analyses, number of debridements, duration of treatment, FG Severity Index (FGSI) score, fecal diversion methods (trephine ostomy or Flexi-Seal Fecal Management System-FMS), and dressing methods (wet or negative aspiration system). In the nonsurvivor group, urea, WBC, and age were significantly higher, whereas albumin, hematocrit, platelet count, and length of hospital stay (LOHS) were significantly lower compared to the survivor group. Mean FGSI was lower in survivors in comparison with nonsurvivors (5.00 ± 1.86 and 10.00 ± 1.27, respectively; P < 0.001). We conclude that FGSI is an important predictor in the prognosis of FG. Vacuum-assisted closure (VAC) should be performed in compliant patients in order to enhance patient comfort by reducing pain and the number of dressings. Fecal diversion should be performed as needed, preferably by using FMS. The trephine ostomy should be the method of choice in cases where an ostomy is necessary.

Fournier’s gangrene: A retrospective analysis of 25 patients

“…[2,3,12,19,20] Among these factors, DM is the most common. [2,4,6,7,9,12,13,15] Diabetes leads to increased susceptibility to infections owing to the suppression of chemotaxis, phagocytosis, and immune functions. Most of our study population (80%) was diabetic.…”

“…VAC enables more comfortable mobilization and reduces the duration of hospital stay. [4,12,[21][22][23] We performed VAC in addition to debridement in 64% of our patients. The mean duration of hospital stay was 26.43 days in our cohort, and the mean number of debridements performed was 2.81 in patients who underwent VAC.…”

“…This emergency surgical condition is associated with a high mortality rate. [1][2][3][4][5] Yücel et al Fournier' s gangrene derness; induration; cyanosis; gangrene; and subcutaneous crepitation were considered to have Fournier's gangrene. The patients were admitted to the hospital ward, and resuscitation was initiated.…”

Trephine stoma: Outcomes in a single center

“…A significant advantage of the TS appeared to be the ability to perform surgery under regional anesthesia [4]. This may be very attractive in the patients with concurrent morbidities, especially pulmonary disease, in whom complications might be decreased by the avoidance of general endotracheal intubation [12], especially in mortal diseases like Fournier's gangrene [13]. In our study, TS was applied under emergency conditions in 9 cases and under elective conditions in 5 cases, and 8 [57%] patients underwent surgery under regional anesthesia.…”

Using negative pressure therapy for improving skin graft taking on genital area defects following Fournier gangrene

“…[9] However in only 10% of the patients with Fournier gangrene reconstruction with skin graft has been preferred. [15] Graft loss is the most frequently seen complication of reconstruction of the defect using skin graft. Graft shearing ranks on top of the reasons for graft loss.…”