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An increase in the share of patients with purulent-septic processes of soft tissues in surgical hospitals was indicated by statistical and epidemiological data. Currently, it amounts to 28.5%. Over the last decade, the frequency of Fournier's gangrene has increased by 2.2–6.4. This is due to the increase in the number of patients with weakened immunity in the population. Objective. To study the features of the clinical course, diagnosis and treatment of necrotizing fasciitis with progressive tissue necrosis of the genital organs and perineum based on clinical cases. Materials and methods. Three clinical cases of rapidly progressive Fournier's gangrene are described, one of which had a fatal outcome. Results. As a result of complex treatment, which included staged surgical correction, antibacterial therapy, detoxification measures, correction of homeostasis, functions of organs and systems, the condition of patients gradually stabilized: we managed to stop the phenomena of systemic inflammatory reaction, localize the purulent-necrotic process within the affected areas, provide stimulation of reparative processes in the wound. Due to the presence of large tissue defects of the scrotum, two patients underwent surgery. By exposing the testicles and spermatic cords, after cleaning the wounds, the scrotum was reconstructed with the closure of the eviscerated organs with mobilized local tissues, autodermal plastic, secondary sutures for the wound defects of the side wall of the abdomen, inguinal areas, and right thigh. One of the three patients, a 74-year-old man, despite receiving conservative and non-surgical treatment, died on the 9th day as a result of the spread of the purulent-necrotic process and the progression of multiple organ failure. Conclusion. The presented experience of treatment of Fournier's gangrene demonstrates the importance of timely intensive treatment of this severe infectious process, which is accompanied by the rapid destruction of perineal tissues and the spread of the process beyond the affected anatomical area and the development of sepsis with a high probability of death.
An increase in the share of patients with purulent-septic processes of soft tissues in surgical hospitals was indicated by statistical and epidemiological data. Currently, it amounts to 28.5%. Over the last decade, the frequency of Fournier's gangrene has increased by 2.2–6.4. This is due to the increase in the number of patients with weakened immunity in the population. Objective. To study the features of the clinical course, diagnosis and treatment of necrotizing fasciitis with progressive tissue necrosis of the genital organs and perineum based on clinical cases. Materials and methods. Three clinical cases of rapidly progressive Fournier's gangrene are described, one of which had a fatal outcome. Results. As a result of complex treatment, which included staged surgical correction, antibacterial therapy, detoxification measures, correction of homeostasis, functions of organs and systems, the condition of patients gradually stabilized: we managed to stop the phenomena of systemic inflammatory reaction, localize the purulent-necrotic process within the affected areas, provide stimulation of reparative processes in the wound. Due to the presence of large tissue defects of the scrotum, two patients underwent surgery. By exposing the testicles and spermatic cords, after cleaning the wounds, the scrotum was reconstructed with the closure of the eviscerated organs with mobilized local tissues, autodermal plastic, secondary sutures for the wound defects of the side wall of the abdomen, inguinal areas, and right thigh. One of the three patients, a 74-year-old man, despite receiving conservative and non-surgical treatment, died on the 9th day as a result of the spread of the purulent-necrotic process and the progression of multiple organ failure. Conclusion. The presented experience of treatment of Fournier's gangrene demonstrates the importance of timely intensive treatment of this severe infectious process, which is accompanied by the rapid destruction of perineal tissues and the spread of the process beyond the affected anatomical area and the development of sepsis with a high probability of death.
Fournier's gangrene (FG) is a life-threatening and special form of necrotizing fasciitis, characterized by occult onset, rapid progress and high mortality, occurring mainly in men over 50 years of age. Risk factors of FG include diabetes, HIV infection, chronic alcoholism and other immunosuppressive state. FG was previously considered as an idiopathic disease, but in fact, three quarters of the infections originated from the skin, urethra and gastrointestinal tract. Initial symptoms of FG are often inconsistent with severity and can progress promptly to fatal infection. Although the treatment measures of FG have been improved in recent years, the mortality does not seem to have decreased significantly and remains at 20% -30%. The time to identify FG and the waiting period before surgical debridement are directly related to the prognosis. Therefore, in addition to the combination of intensive fluid resuscitation and broad-spectrum antibiotics, treatment of FG should particularly emphasize the importance of early surgical debridement assisted with fecal diversion and skin reconstruction when necessary. This paper is to briefly summarize the progress in the definition, epidemiology, clinical manifestations, diagnosis, treatment and prognosis of Fournier's gangrene in recent years, more importantly, illustrates the importance of multidisciplinary cooperation in the management of FG.
Background: Fournier’s gangrene (FG) is a life-threatening, necrotizing infection. Due to the rareness of the disease, it is challenging to plan robust prospective studies. This study aims to describe current practice patterns of FG in Europe and identify implications for planning a prospective FG registry. Methods: Online non-validated 17-items survey among urologists treating FG in in European hospitals. Questionnaires were analyzed with LimeSurvey (LimeSurvey GmbH Hamburg, Germany). Results: 229 responses from ten different European countries were submitted, and 117 (51.1%) urologists completed the questionnaire. The departments treat a mean of 4.2 (SD 3.11) patients per year. The urology department mostly takes the lead in treating FG patients (n = 113; 96.6%). The practice in FG is very heterogenic and mostly case-based all over Europe, e.g., vacuum-assisted wound closure (VAC) is mostly used (n = 50; 42.7%) as adjunct wound. The biggest challenges in FG are the short time to diagnosis and treatment, standardization and establishment of guidelines, and disease awareness. Additionally, participants stated that an international registry is an outstanding initiative, and predictive models are needed. Conclusions: There is no standard of care in the diagnosis, treatment, and long-term care of FG all over Europe. Further research could be conducted with a prospective registry.
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