Factors affecting the number of debridements in Fournier's gangrene: our results in 36 cases

Göktaş, Cemal; Yıldırım, Mehmet; Horuz, Rahim; Faydaci, Gokhan; Akça, Oktay; Cetinel, Cihangir

doi:10.5505/tjtes.2012.36599

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…[14] The recurrence of necrosis in FG may be resulting from inadequate number of debridement, therefore, implementation of multiple debridement's (averagely 1.5, 3.3 or 3.5, respectively) is recommended, although recommended number varies between studies. [5,15,16] Mean number of debridement's was 2.94 in our study. Although the diagnosis of FG is mainly based on clinical findings, we routinely used ultrasonography in the presence or suspicion of FG.…”

Section: Discussionsupporting

confidence: 46%

Our experience on Fournier’s gangrene in a tertiary-stage care center and analysis of its relationship with blood count parameters

Topuz¹

2021

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Fournier's gangrene (FG) is rapidly progressing and life-threatening necrotizing fasciitis of genital and perineal regions. The aim of the study was to share our experience with FG and to analyze the relationship of clinical data with whole blood count parameters, inflammation cells, and systemic inflammation markers. METHODS:The digital medical records of the adult patients followed-up and treated with diagnosis of FG between January 2016 to December 2020 were retrospectively analyzed. Data were as age, gender, total length of hospital stay, predisposing factors, etiological factors, total number of debridement's, surgical procedures, and antibiotherapy were collected. Serum glucose levels, complete blood count parameter levels, serum inflammation indicators and C-reactive protein (CRP) levels measured at the initial day of hospital admission, post-debridement 1 st and 7 th days were measured. RESULTS:Thirty-six male patients were included, with a mean age of 56.42 (22-86) years. The most common predisposing factor was diabetes mellitus (n=13; 36.1%). The most frequently seen etiological cause was scrotal abscess (n=19; 52.8%). A statistically significant decrease was found in White blood cell count, neutrophil level, neutrophil-to-lymphocyte ratio (NLR) value and CRP level measured before debridement, post-debridement 1 st and 7 th days (p<0.05). There was a positive correlation between the number of debridement's and age, NLR, platelet-to-lymphocyte ratio, and CRP values at the initial admission time (p<0.05). CONCLUSION:The infections of urogenital region are the essential etiological origin of FG. As a rare urological emergency, significant changes were observed in clinical data and blood count parameters during the course of FG.

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Section: Discussionsupporting

confidence: 46%

Our experience on Fournier’s gangrene in a tertiary-stage care center and analysis of its relationship with blood count parameters

Topuz¹

2021

Ulus Travma Acil Cerrahi Derg

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“…Mortality in FG has traditionally been substantial, ranging from 6.4 to 40 per cent. 5,6,12,14,[25][26][27][28][29][30][31][32][33][34][35] The high mortality rate seen historically in patients with FG is likely multifactorial, encompassing preexisting patient comorbidities, organ dysfunction, local disease spread, and time to debridement. [1][2][3]17 Advances in critical care probably contribute to the low mortality seen in this review when compared with previously published series.…”

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confidence: 99%

Definitive Wound Closure Techniques in Fournier's Gangrene

Lauerman

Kolesnik

Park

et al. 2018

The American Surgeon™

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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.

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