Management protocol for Fournier’s gangrene in sanitary regime caused by SARS-CoV-2 pandemic: A case report

Grabińska, Agnieszka; Michalczyk, Łukasz; Banaczyk, Beata; Syryło, Tomasz; Ząbkowski, Tomasz

doi:10.12998/wjcc.v9.i5.1215

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…However, this is the first report in the literature of a series of cases of FG in patients with COVID-19. There are only publications in the literature describing one case so far (14)(15)(16)(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and Fournier’s Gangrene: Is there a Correlation Between Both Diseases?

Parra¹,

Feitosa²,

Freitas³

et al. 2023

JHS

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Background: Reports on the development of Fournier's Gangrene (FG) in patients with coronavirus disease 2019 (COVID-19) are rare. Aim: This study reports a series of cases of patients with both diseases and to summarize the literature on the subject. Methods: We retrospectively examined electronic medical records dated between March 2020 and December 2021 of all adult patients with COVID-19 admitted to the Clinics Hospital of Ribeirão Preto (HCFMRP-USP) to identify those who had a diagnosis of FG. The diagnosis of COVID-19 was made by RT-PCR. We assessed the following patient characteristics: age; sex; tobacco use; laboratory data; and comorbidities such as human immunodeficiency virus (HIV), obesity, diabetes mellitus, systemic arterial hypertension, and alcoholism. Results: Four patients met the inclusion criteria. All the patients were female and had at least two comorbidities, including obesity (n=4, 100%), systemic arterial hypertension (n=3, 75%), diabetes mellitus (n=2, 50%), cardiovascular disease (n=1, 25%), chronic kidney disease (n=1, 25%), and hematologic disorders (n=1, 25%). They were all admitted to the intensive care unit and underwent surgical debridement under anesthesia. All the patients received hyperbaric oxygen therapy. The mean age was 62.75 years (range 60-66 years), and the mean length of stay was 30 days (range 22-37 days). One patient died (n=1, 25%). Conclusion: This is the first report in the literature on a series of cases of FG in patients with COVID-19. FG associated with COVID-19 is a serious, potentially lethal condition.

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Section: Discussionmentioning

confidence: 99%

COVID-19 and Fournier’s Gangrene: Is there a Correlation Between Both Diseases?

Parra¹,

Feitosa²,

Freitas³

et al. 2023

JHS

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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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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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Management protocol for Fournier’s gangrene in sanitary regime caused by SARS-CoV-2 pandemic: A case report

Cited by 3 publications

References 11 publications

COVID-19 and Fournier’s Gangrene: Is there a Correlation Between Both Diseases?

COVID-19 and Fournier’s Gangrene: Is there a Correlation Between Both Diseases?

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

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

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