Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review

Lewis, Gregory D.; Majeed, Maliha; Olang, Catherine A; Patel, Arjun; Gorantla, Vasavi Rakesh; Davis, Nelson; Gluschitz, Sarah

doi:10.7759/cureus.18948

Cited by 32 publications

(55 citation statements)

References 51 publications

(68 reference statements)

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“…The onset of this necrotizing fasciitis is insidious with up to 40% of cases asymptomatic. When signs and symptoms are the reason of emergency access, they are characterized by genital and perineal regions pain with little to no visible cutaneous damage in the early stage and erythematous and dusky skin, crepitus of subcutaneous tissue, maleodorant and purulent exudates of perineal and genital regions [ 206 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the necrotizing fasciitis could benefit from hyperbaric oxygen therapy (HBOT) to reduce the spread of anaerobic germs, from the vacuum-assisted closure (VAC) that can be used to promote wound healing physiologically reducing the need for reconstructive surgery with skin graft in the setting of a personalized medicine [ 206 , 209 – 211 ]. HBOT has been related to a better wound control as an adjuvant treatment by promoting wound healing.…”

Section: Discussionmentioning

confidence: 99%

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Management of Fournier’s gangrene during the Covid-19 pandemic era: make a virtue out of necessity

Paladini

Cochetti

Tancredi

et al. 2022

Basic Clin. Androl.

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Background Fournier’s gangrene (FG) is a necrotizing fasciitis caused by aerobic and anaerobic bacterial infection that involves genitalia and perineum. Males, in their 60 s, are more affected with 1.6 new cases/100.000/year. Main risk factors are diabetes, malignancy, inflammatory bowel disease. FG is a potentially lethal disease with a rapid and progressive involvement of subcutaneous and fascial plane. A multimodal approach with surgical debridement, antibiotic therapy, intensive support care, and hyperbaric oxygen therapy (HBOT) is often needed. We present the inpatient management of an FG case during the Covid-19 pandemic period. A narrative review of the Literature searching “Fournier’s gangrene”, “necrotizing fasciitis” on PubMed and Scopus was performed. Case presentation A 60 years old man affected by diabetes mellitus, with ileostomy after colectomy for ulcerative colitis, was admitted to our Emergency Department with fever and acute pain, edema, dyschromia of right hemiscrotum, penis, and perineal region. Computed tomography revealed air-gas content and fluid-edematous thickening of these regions. Fournier’s Gangrene Severity Index was 9. A prompt broad-spectrum antibiotic therapy with Piperacillin/Tazobactam, Imipenem and Daptomycin, surgical debridement of genitalia and perineal region with vital tissue exposure, were performed. Bedside daily surgical wound medications with fibrine debridement, normal saline and povidone-iodine solutions irrigation, iodoform and fatty gauze application, were performed until discharge on the 40th postoperative day. Every 3 days office-based medication with silver dressing, after normal saline and povidone-iodine irrigation and fibrinous tissue debridement, was performed until complete re-epithelialization of the scrotum on the 60th postoperative day. Conclusions FG is burdened by a high mortality rate, up to 30%. In the literature, HBOT could improve wound restoration and disease-specific survival. Unfortunately, in our center, we do not have HBOT. Moreover, one of the pandemic period problems was the patient’s displacement and outpatient hospital management. For all these reasons we decided for a conservative inpatient management. Daily cleaning of the surgical wound allowed to obtain its complete restoration avoiding surgical graft and hyperbaric oxygen chamber therapy, without foregoing optimal outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of Fournier’s gangrene during the Covid-19 pandemic era: make a virtue out of necessity

Paladini

Cochetti

Tancredi

et al. 2022

Basic Clin. Androl.

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“…Escherichia coli and Bacteroides fragilis are the two main organisms associated with Fournier's gangrene. They work in concert to release collagenase enzymes that cause extensive tissue damage at a rate of one inch per hour and can spread to the anterior abdominal wall and vital organs, causing multi-organ failure and septic shock [3]. Diabetes has been a significant risk factor, reported in several cases.…”

Section: Introductionmentioning

confidence: 99%

“…Diabetes has been a significant risk factor, reported in several cases. There are other comorbid conditions associated with FG, such as HIV, advanced age, alcoholism, smoking, obesity, atherosclerosis, and malnutrition [3,4]. Pain and discomfort in the perineum and genital area are the typical patient complaints at the initial presentation of FG.…”

Section: Introductionmentioning

confidence: 99%

Fournier’s Gangrene: A Coexistence or Consanguinity of SGLT-2 Inhibitor Therapy

Chowdhury¹,

Gousy²,

Bellamkonda³

et al. 2022

Cureus

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Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are a relatively new class of medications used for the management of type II diabetes mellitus targeting the kidneys. Within the last decade, several warnings have been issued regarding the development of severe genitourinary infections, including necrotizing fasciitis, or Fournier's gangrene, in those with pre-existing type II diabetes and concomitant use of this drug class.Objective: The purpose of this review is to highlight and discuss the factors contributing to the development of Fournier's gangrene, its pathogenesis, and a review of existing literature describing patient outcomes, treatment, and future directions regarding early detection of this complication.Methods: Articles and studies addressing effective treatment adherence and key factors contributing to Fournier's gangrene with SGLT2 inhibitors were identified by effective keyword searches in PubMed Central, Google Scholar, and Cochrane, as well as the references found within these articles.Results: Using the keywords provided, 55 case reports, review articles, and meta-analysis reports written within the last 20 years were utilized as the source of the data presented in this systematic review article.

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“…Fournier's Gangrene (FG) is a rapidly spreading necrotizing fasciitis that spreads through the superficial and deep fascial layers in the perineal, genital, or perianal regions, causing multiple organ failure, septic shock and sometimes death. 1,2,3 The disease affects men, women 4,5 and even children. 6 FG was first described by Baurienne in 1764, but Jean Alfred Fournier, a Parisian Venereologist, is more commonly credited with discovering the disease.…”

Section: Introductionmentioning

confidence: 99%

Fournier’s Gangrene Post Circumcision in a Tertiary Hospital in Southern Nigeria

Abhulimen¹,

Francis²

2022

EJHS

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Purpose: Fournier’s gangrene is a rapidly progressing necrotizing fasciitis. It is a true urological emergency. It is a relatively rare condition. The aim was to highlight the presentation and management of Fournier’s gangrene following circumcision. Methodology: This was a retrospective study. Eight patients who presented with features of Fournier’s gangrene post circumcision between January 2012 and December 2021 to University of Port Harcourt Teaching Hospital UPTH were included in the study. A questionnaire was used to obtain data from all patients listed in the medical records department as having been treated for Fournier’s gangrene during the study period. Data collected include age at presentation, level of education of mother, duration of symptoms before presentation, who carried out the circumcision, where the circumcision was carried out, number of debridement carried out and complications. The data was entered using Microsoft Excel 2016 version and transferred into the statistical package for social sciences (SPSS) for windows (version 20) (IBM SPSS Inc. Chicago, IL) for analysis. Categorical data was presented in the form of frequencies and percentages using tables. Continuous variables were presented in means and standard deviation. Results were presented in tables and charts. Findings: A total of eight patients had FG following circumcision. The median age was 14days and range was from 10 days to 10years. The parents of most patients (87.5%) presented with no formal education or primary level of education. Most patients (62.5%) presented 4 to 6 days after onset of symptoms. Five out of 8 had their circumcision by a traditional attendant. Three patients had complications. One patient died. Circumcision can be a predisposing factor to FG especially if it is carried out at home, and by untrained personnel. Early presentation and management gives the best outcome. Recommendation: Only trained personnel should carry out circumcision. When parents or caregivers notice any unusual change post circumcision, they should present immediately to the hospital.

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Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review

Cited by 32 publications

References 51 publications

Management of Fournier’s gangrene during the Covid-19 pandemic era: make a virtue out of necessity

Management of Fournier’s gangrene during the Covid-19 pandemic era: make a virtue out of necessity

Fournier’s Gangrene: A Coexistence or Consanguinity of SGLT-2 Inhibitor Therapy

Fournier’s Gangrene Post Circumcision in a Tertiary Hospital in Southern Nigeria

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