Fournier Gangrene

Abstract

Fournier gangrene is an acute and potentially fatal infection of the scrotum, perineum, and abdominal wall. It is characterized by necrotizing fasciitis with loss of subcutaneous tissue and skin. The aim of this study was to analyze the prognosis and treatment effectiveness of this fulminant infectious disease. Forty-one patients were admitted to our hospital with the diagnosis of Fournier gangrene between January 1998 and December 2006. The patients' age, sex, predisposing factors, duration of symptoms and hospital stay, time to operation, size of the skin defect, bacteria isolated, treatment modalities, and outcomes were reviewed. The data were analyzed by chi2 analysis and Student t test. A P-value <0.05 was considered significant. The mean age of the patients was 57.2 years. The most common predisposing factor was diabetes mellitus in 21 patients (51.2%), followed by cirrhosis of the liver, uremia, alcoholism, and underlying malignancy. The most common symptoms were fever (87.8%) and pain or swelling over the genital region (85.4%). The initial treatment included extensive debridement and open drainage. Time to operation ranged from 1 to 10 days. Reconstructive surgery was performed for 22 patients. The mortality rate was 19.5%. Delayed debridement was a significant factor affecting the survival rate. Our study is a retrospective study of patients with Fournier gangrene undergoing debridement and reconstructive procedure. Because of the fulminant course of Fournier gangrene, it may be difficult to design a prospective study. Fournier gangrene is a severe infectious disease with a high mortality rate. Early and aggressive debridement is a significant prognostic factor in the management of Fournier gangrene. Several reconstructive modalities are useful to correct the tissue defect. Early debridement and reconstructive surgery for wound coverage improve the quality of life.

Successful combined approach to a severe fournier’s gangrene

“…[234] Originally FG was considered an idiopathic disease but today is often possible to identify the sources of the infections, that frequently arise from cutaneous trauma or urogenital and colorectal diseases. [23456] Many species of bacteria, including aerobic and anaerobic, are isolated from the wounds, most frequently in combination rather than single. These organisms, usually commensal of the digestive and urogenital tract, become pathogenic and act synergistically to cause extensive tissue damage.…”

“…These organisms, usually commensal of the digestive and urogenital tract, become pathogenic and act synergistically to cause extensive tissue damage. [2345678] Systemic disorders that compromise the immune system have been implicated in the development of FG. Diabetes mellitus, alcoholism, obesity, malignancy and immunosuppression are the most common comorbidities associated with the disease.…”

“…FG frequently results from a polymicrobial infection in a susceptible immunocompromised host. [23456]…”

Aesthetic scrotal reconstruction following extensive Fournier’s gangrene using bilateral island pedicled sensate anterolateral thigh flaps: A case report

“…[1][2][3]16 Early aggressive serial debridement and intravenous antibiotics, followed by some form of durable wound coverage, is standard therapy. [1][2][3]14,15,17 Because most patients with Fournier's gangrene are older with comorbidities, comesis may not be a primary consideration in the reconstruction. As a young, healthy male, our patient was concerned about his appearance, sensation and sexual function.…”

“…[1][2][3] Several techniques have been described to provide durable coverage, but do not necessarily provide an ideal cosmetic result. [4][5][6][7][8][9][10][11][12][13][14][15] We describe our treatment of a young, healthy male with extensive Fournier's gangrene with loss of the scrotum. Bilateral neurotized anterolateral thigh (ALT) flaps were used to achieve a sensate and aesthetically acceptable result.…”