Fournier’s Gangrene

doi:10.4172/2165-7548.1000183

Emergency Medicine

2014

DOI: 10.4172/2165-7548.1000183

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Fournier’s Gangrene

Abstract: Fournier's gangrene is a usually polymicrobial, necrotizing, life-threatening fasciitis of the perineal, genital and perianal region. It is a fulminant disease which can rapidly spread to the abdominal wall and cause a high mortality. It is important to diagnose the disease process as early as possible as when the tyreatment is delayed mortality rate is directly increased.

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Cited by 2 publications

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Fournier’s gangrene: the current state of the problem and our treatment experience

Aliyev

Алиев

2022

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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The OBJECTIVE of the study was to analyze the results of treatment of patients with lightning scrotal gangrene (Fournier’s gangrene).METHODS AND MATERIAL. The work is based on the analysis of the results of treatment of 31 patients with Fournier’s gangrene aged 32 to 82 years. In 19 (61.3 %) patients, the most probable nosological causes of Fournier’s gangrene were diseases of the anorectal zone, in 10 – pathology of the urogenital sphere. In 2 patients, Fournier’s gangrene developed as a result of a closed injury (1) and a gunshot wound (1) of the perineum and scrotum. A limited (slowly progressing) form of the disease was observed in 18 (58.1 %) patients, a common form with a lightning (9) and rapidly progressing (4) course – in 13 (41.9 %). 6 (19.3 %) patients suffered from diabetes mellitus of varying severity. In all patients, the clinical manifestations of the disease and laboratory parameters were characterized by the phenomena of generalized surgical infection with signs of systemic inflammatory response syndrome and endotoxicosis. In 93.5 % of patients, causative microflora was represented by various associations of both facultative-anaerobic and obligateaerobic gram-negative and obligate-facultative anaerobic gram-positive microorganisms. The growth of anaerobic gramnegative non-clostridial flora was also obtained.RESULTS. Out of 31 patients, 6 (19.3 %) patients died who had a common form of FG with a lightning and rapidly progressing clinical course in the format of systemic inflammatory response syndrome and systemic endotoxicosis with an outcome in organ-system dysfunction. The causes of death were: septic shock (in 1), progressive systemic endotoxicosis (sepsis) with the outcome of multiple organ failure (in 3) and pulmonary embolism (in 2).CONCLUSION. Multidisciplinary approach to solving organizational and therapeutic and tactical tasks with the participation of doctors of related specialties, active surgical tactics in the format of «aggressive surgery», providing for the widest possible excision of necrotic and non-viable tissues, performed in combination with programmed (stage-by-stage) sanitation necrectomy, pathogenetically justified correction of violations of the homeostasis system, rational antibacterial therapy, a comprehensive system of local wound treatment and plastic replacement of lost integumentary tissues are priority ways to optimize the results of treatment of patients with Fournier’s gangrene.

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Fournier’s gangrene: the current state of the problem and our treatment experience

Aliyev

Алиев

2022

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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Fournier's gangrene аs a multidisciplinary problem of purulent septic surgery

Aliyev,

Aliyev

2023

jour

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The article is dedicated to the current problem of pyoseptic surgery, presenting an analytical review of the systematic literature that covers one of the rare forms of necrotizing fasciitis — Fournier’s gangrene. From the perspective of an evolutionary approach, the historical milestones in the formation of scientifi c views on the essence and etiopathogenesis of the disease, its epidemiology, classifi cation, clinical presentation, diagnosis, and treatment are presented. In the context of the defi nition, it is declared that in the modern understanding, “Fournier’s gangrene” implies a particular (specifi c) model of critical conditions in surgery, which is characterized by progressive purulent-necrotic lesions and putrefactive decomposition of fascial and soft tissue structures of the external genitalia, manifesting with systemic endotoxemia, septic shock, and high mortality rates. It is postulated that the intravascular invasion of causative microfl ora is at the basis of the pathogenetic mechanism of Fournier’s gangrene development, resulting in disseminated thrombosis of the microcirculatory bed of the superfi cial fascia of the scrotum. In accordance with the principles of evidence-based medicine, modern methods of diagnosis and treatment are outlined. It is shown that urgent surgical intervention in the format of “aggressive surgery,” with the main component being “manual elimination” of necrotic and non-viable tissues achieved through programmed (staged) sanitation necrectomy, is a priority in the treatment of patients with Fournier’s gangrene. Issues of adjuvant therapy using methods such as laser sanitation, vacuum wound therapy, and hyperbaric oxygenation are discussed. Based on a multifactorial analysis of data from contemporary literature, it is declared that a crucial condition that signifi cantly infl uences treatment outcomes and disease prognosis is a multidisciplinary approach to solving diagnostic and therapeutic tasks involving doctors from related specialties (surgeons, coloproctologists, urologists, dermatologists, intensivists, radiologists, bacteriologists).

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Fournier’s Gangrene

Cited by 2 publications

References 20 publications

Fournier’s gangrene: the current state of the problem and our treatment experience

Fournier’s gangrene: the current state of the problem and our treatment experience

Fournier's gangrene аs a multidisciplinary problem of purulent septic surgery

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