Necrotizing Fasciitis of the Perineum and the Abdominal Wall-Surgical Approach

Abstract

Necrotizing fasciitis is a synergistic aerobical-anaerobical infection that rapidly spreads from its origin leading to foudroyant increasing soft tissue gangrene and systemic sepsis. In the perineal, perianal and genital regions it is referred to as Fournier's gangrene constituting a clinical entity with the gangrene of the abdominal wall. After a short presentation of the own experience with 17 patients the surgical approach to the life-threatening disease is presented reviewing the former and the recent literature. There is a worldwide consensus that immediate radical excision of the gangrene should be accompanied by intensive care measures. Functional and cosmetic defects are to be reconstructed in a second stage. However, morbidity and mortality remain high in spite of consequent treatment due to often associated significant co-morbidity of affected patients.

Fournier’s gangrene: analysis of prognostic variables in 34 patients

“…In our study, colorectal and trauma were the most frequent etiologies. In several studies, a colorectal origin was associated to a worse prognosis due to the higher number of microorganisms isolated [2,3]. However, in our series, the mortality rate was higher in genitourinary (50%) and trauma (42%) origins, due to two cases of nonsurgical malignancies and three cases of pressure ulcers.…”

“…Multidisciplinary treatment seems to be the best approach, and includes hemodynamic support in an ICU, broad-spectrum antibiotic therapy and aggressive surgical debridement, even with supra-pubic catheterization, colostomy and orchiectomy. Despite an improved overall management, the mortality rate is still high (up to 70%) [1][2][3].…”

Fournier’s Gangrene: Etiology and Outcome Analysis of 41 Patients

“…Although the disease is rare and accounts for 0.02% of all admissions to urology wards, it usually occurs in patients who are immunosuppressed due to comorbidities and who develop a primary infection site such as an abscess [2,4]. Despite a multidisciplinary approach that includes broad-spectrum antibiotics, radical surgical debridement and hemodynamic support in an intensive treatment unit, mortality rates are still very high [5]. The mortality rates are between 20 and 40% in most reports, but vary greatly and range from 4 to 88% [4].…”

Soft Tissue: Infection and Reconstruction

“…In their articles, the authors discuss the surgical treatment of necrotizing faciitis in the perineum and abdominal wall (also referred to as Fournier's gangrene) and in the upper and lower extremities (causing compartment syndrome) [1,2]. They take the reader through the multiple and aggressive debridement required to arrest the spread of infection and remove the necrotic tissue and many subsequent reconstructive techniques used to prevent or minimize long-term deformities and loss of function.…”