Fournier???s Gangrene: Etiology, Treatment, and Complications

Kılıç, Azize; Aksoy, Yakup; Kılıç, Levent

doi:10.1097/00000637-200111000-00009

Cited by 52 publications

(18 citation statements)

References 7 publications

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“…This condition was officially named as FG despite the fact that it has been originally described by Baurienne in 1764, by Pouteau in 1783, by Jones in 1871, and later by Avicenna in 1877 (4, 6–17). According to Fournier, the disease is characterized by an abrupt onset of painful scrotal swelling and a rapid progression to gangrene in otherwise healthy men without any obvious or definite cause (3, 4, 7, 8, 10, 11, 13, 14, 17, 26, 32, 36). Many different terms including idiopathic gangrene of the scrotum, periurethral phlegmon, streptococcal scrotal gangrene, gangrenous erysipelas of the scrotum, and synergistic necrotizing cellulitis have been used to describe this clinical entity over the years (8, 9, 11–13).…”

Section: Discussionmentioning

confidence: 99%

“…Fournier’s gangrene is an infection caused by aerobic and anaerobic bacteria, usually acting synergistically that spread along the subcutaneous and fascial planes across the perineum, scrotum and sometimes beyond these tissues leading to thrombosis of subcutaneous vasculature and skin necrosis (4, 7, 10). This typical clinical picture of gangrene generally starts in the scrotal region and rapidly spreads to the penis, perineum, and inner thighs (4).…”

Section: Discussionmentioning

confidence: 99%

“…In patients developing FG, there are frequently a number of comorbidities (1, 3–5, 7–18, 26, 29–36). Diabetes mellitus, alcoholism, immunosuppression, chemotherapy, chronic corticosteroid use, HIV, leukemia, cardiac disorders, systemic lupus erythematosus, obesity, liver disease, Crohn’s disease, and kidney failure are some of the comorbid risk factors for the development of FG (1, 3–5, 7–18, 26, 29–36).…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes mellitus, alcoholism, immunosuppression, chemotherapy, chronic corticosteroid use, HIV, leukemia, cardiac disorders, systemic lupus erythematosus, obesity, liver disease, Crohn’s disease, and kidney failure are some of the comorbid risk factors for the development of FG (1, 3–5, 7–18, 26, 29–36). Diabetes mellitus is present in 20–70% of patients with Fournier gangrene (9, 11).…”

Section: Discussionmentioning

confidence: 99%

“…First, bacteria in the lower urinary tract can move to the paraurethral gland and corpus spongiosum and through the Buck’s fascia the infection can extend to Dartos, Colles’, and Scarpa fascia (7, 33). The infecting bacteria probably pass through Buck’s fascia of the penis and spread along the Dartos fascia of the scrotum and penis, Colles’ fascia of the perineum, and Scarpa’s fascia of the anterior abdominal wall (3, 7, 11, 26, 33). The second route for the infection begins around the rectum and spreads directly to the scrotum and testis through Colles’ fascia (3, 7, 33).…”

Section: Discussionmentioning

confidence: 99%

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Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

et al. 2017

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BackgroundFournier’s gangrene (FG) is a rapidly evolving necrotizing fasciitis of the perineum and the genital area, the scrotum as it most commonly affects man in the vast majority of cases. It is polymicrobial in origin, due to the synergistic action of anaerobes and aerobes and has a very high mortality. There are many predisposing factors including diabetes mellitus, alcoholism, immunosuppression, renal, and hepatic disease. The prognosis of the disease depends on a lot of factors including but not limited to patient age, disease extent, and comorbidities. The purpose of the study is to describe the experience of a general surgery department in the management of FG, to present the multimodal and multidisciplinary treatment of the disease, to identify predictors of mortality, and to make general surgeons familiar with the disease.MethodsThe current retrospective study is presenting the experience of our general surgery department in the management of FG during the last 20 years. The clinical presentation and demographics of the patients were recorded. Also we recorded the laboratory data, the comorbidities, the etiology, and microbiology and the therapeutic interventions performed, and we calculated the various severity indexes. Patients were divided to survivors and non-survivors, and all the collected data were statistically analyzed to assess mortality factors using univariate and then multivariate analysis.ResultsIn our series, we treated a total of 24 patients with a mean age 58.9 years including 20 males (83.4%) and 4 females (16.6%). In most patients, a delay between disease onset and seeking of medical help was noted. Comorbidities were present in almost all patients (87.5%). All patients were submitted to extensive surgical debridements and received broad-spectrum antibiotics until microbiological culture results were received. Regarding all the collected data, there was no statistically significant difference between survivors and non-survivors except the presence of malignancy in non-survivors (p = 0.036) and the lower hemoglobin (p < 0.001) and hematocrit (p = 0.002) in non-survivors. However, multivariate analysis did not reveal any predictor of mortality.ConclusionEarly diagnosis, aggressive thorough surgical treatment, and administration of the proper antibiotic treatment comprise the cornerstone for the outcome of this disease. In small populations like in the present study, it is difficult to recognize any predictors of mortality and even the severity indexes, which take into account a lot of data cannot predict mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

et al. 2017

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Posteromedial thigh (PMT) propeller flap for perineoscrotal reconstruction: A case report

2015

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Fournier's gangrene can lead to extensive defects of the perineoscrotal area with exposure of the testes. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Due to its proximity, medial thigh skin appeared to be the most versatile donor site for perineoscrotal reconstruction. In this report, we present a case of reconstruction of a large perineoscrotal defect because of Fournier's gangrene using a posteromedial thigh (PMT) perforator propeller flap. A 58 year-old male who suffered from Fournier's gangrene resulted in a scrotal defect of 10 × 12 cm(2) with a large dead space. A pedicled PMT propeller flap measuring 9 × 23 cm(2) with two perforators that originated from the profunda femoris artery (PFA) was harvested for scrotal defect reconstruction and dead space obliteration. The flap survived completely, with no recipient or donor site morbidity. The length of followup was 3 months and was uneventful. The pedicled PMT propeller flap may be considered as a valid option for perineoscrotal reconstruction.

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Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene

et al. 2016

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Fournier's gangrene is an acute and potentially lethal necrotizing fasciitis that can lead to extensive defects of the perineoscrotal area and lower abdominal wall as well. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Local perforator pedicle flaps and muscle flaps can be employed and combined for such a reconstruction. In this report we present a case of reconstruction of a massive perineoscrotal and upper medial thigh defect because of Fournier's gangrene using a bilateral pedicle anterolateral thigh (ALT) flap and sartorius muscle flap. A 61 year-old male who suffered from Fournier's gangrene resulted in a perineal, scrotal, and medial thigh defect of 27 × 30 cm with exposure of the femoral vessels. A bilateral pedicle ALT flap measuring 30 × 9 cm based on two perforators and a bilateral sartorius muscle flap were harvested for soft tissue defect reconstruction and inguinal vessels coverage, respectively. The flaps survived completely, with no recipient or donor site morbidity. The length of follow-up was 6 months and was uneventful. A bilateral pedicle ALT flap combined with bilateral sartorius flap may be considered as a valid and safe option for an extensive inguinal and perineoscrotal reconstruction in selected cases. © 2016 Wiley Periodicals, Inc. Microsurgery 37:669-673, 2017.

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Fournier???s Gangrene: Etiology, Treatment, and Complications

Cited by 52 publications

References 7 publications

Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

Posteromedial thigh (PMT) propeller flap for perineoscrotal reconstruction: A case report

Bilateral pedicle anterolateral thigh (ALT) flap combined with bilateral sartorius muscle flap for reconstruction of extensive perineoscrotal and medial thigh defect because of Fournier's gangrene

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