Definitive Wound Closure Techniques in Fournier's Gangrene

Abstract

Necrotizing soft tissue infection of the perineum, or Fournier's gangrene (FG), is a morbid and mortal diagnosis. Despite the severity of FG, the optimal definitive wound closure strategy is unknown, as are long-term wound outcomes. A retrospective review was performed over a 3-year period at a single trauma center. Patients were managed according to our institutional approach focusing on primary wound closure and secondary intention healing in residual wounds. Overall 168 patients were included. Complete primary wound closure was accomplished in 39.9 per cent of patients. Patients undergoing primary wound closure were primarily male (89.6 vs 64.4%, P < 0.001), had lower mean sequential organ failure assessment (SOFA) scores (1.70 ± 2.30 vs 2.98 ± 3.36, P = 0.004), more often had perineum-limited FG (67.2 vs 42.6%, P = 0.003), and required fewer debridements (2.40 vs 2.79, P = 0.02). On logistic regression, predictors of primary closure included gender (odds ratio 4.643, 95% confidence interval 1.885–11.437, P = 0.001) and SOFA score (odds ratio 0.834, 95% confidence interval 0.727–0.957, P = 0.01). Wound healing rates increased over time, to an 82.1 per cent wound healing rate without further intervention at greater than six months of follow-up. Wounds healed with secondary intention ranged from 70 to 9520 cm3 and primary closure ranged from 126 to 6912 cm3, whereas wounds requiring skin grafts ranged from 405 to 16,170 cm3. Complete primary wound closure is often achievable in FG patients. Using this standardized approach to FG wound management, even large wounds and wounds undergoing secondary intention healing will often close with long-term wound care and do not require flap creation or early skin grafting.

Scoring Systems for the Prediction of Mortality in Patient with Fournier’s Gangrene: an Analysis of 60 Patients

“…Besides, the SOFA score remained its significance on logistic regression analysis. In the present study, the mean SOFA scores were calculated as 1.8 SD 1.1 and 3.8 SD 0.6 for survivors and non-survivors similar to the above mentioned study [7]. Besides, we showed its predictive power for mortality of FG.…”

“…The SOFA score has been used for identification of sepsis among patients who are critically ill [23]. Up to date, there is only one study in which the SOFA score was studied in FG patients [7]. In this study, the authors reported that lower mean SOFA scores (1.70 SD 2.30 vs. 2.98 SD 3.36) were significantly associated with the probability of primary wound closure.…”

“…For SOFA score, six different organ systems including include respiratory, circulatory, renal, hematology, hepatic, and central nervous were scored from 1 to 4 according to the degree of dysfunction [7]. The sum of each system score was defined as the SOFA score (Suppl.…”

“…The Uludag Fournier Gangrene Severity Index (UFGSI) has been also designed to predict the mortality in FG patients [2]. In addition, several indexes and scoring systems, including the Age-adjusted Charlson Comorbidity Index (ACCI) and the Sequential Organ Failure System (SOFA), have been also used for predicting patient survival in FG [4,7]. However, no single reliable tool for predicting severity and survival of FG is currently available [8][9][10].…”

Practical Review of the Current Management of Fournier’s Gangrene

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