Fournier’s Gangrene in Patients with Oncohematological Diseases: A Systematic Review of Published Cases

Abstract

Patients suffering from hematological malignancies are at increased risk of Fournier’s gangrene (FG) due to immunosuppression caused by the disease itself or by disease-related treatments. A systematic review of PubMed, ISI Web of Knowledge, and Scopus databases was performed in June 2021. We included full papers that met the following criteria: original research, human studies, and describing clinical presentation, treatment, and outcomes of FG in patients with oncohematological diseases. We identified 35 papers published from 1983 to 2021 involving 44 patients (34 males, 8 females) aged between 4 days and 83 years. The most common malignant hematological disorders were acute myeloid leukemia (n = 21) and acute lymphocytic leukemia (n = 9). In 10 patients FG represented the first presentation of hematological malignancy. Scrotum (n= 27) and perineum (n = 11) were the sites most commonly involved. Pseudomonas aeruginosa (n = 21) and Escherichia coli (n = 6) were the most commonly isolated microorganisms. Surgery was performed in 39 patients. Vacuum-assisted closure and hyperbaric oxygen therapy were adopted in 4 and in 3 patients, respectively. Recovery was achieved in 30 patients. FG-related mortality was observed in 11 patients. FG should be carefully considered in patients with oncohematological diseases.

Reconstruction of the Scrotum With Bilateral Gracilis Muscle Rotational Flaps in a Patient With Acute Myeloid Leukemia Complicated by Fournier’s Gangrene

“…A systemic review published in 2021 found only 44 documented cases of Fournier’s gangrene as a complication of hematogenous malignancy or its treatment, with only a fraction of them being attributed to AML specifically [ 5 ]. Two of the 44 identified cases underwent reconstruction using musculocutaneous flaps, with one being a pediatric patient, and both of whom died shortly after the operation [ 5 , 11 , 12 ]. Neither received bilateral gracilis muscle flaps as their method of reconstruction [ 5 , 11 , 12 ].…”

“…Two of the 44 identified cases underwent reconstruction using musculocutaneous flaps, with one being a pediatric patient, and both of whom died shortly after the operation [ 5 , 11 , 12 ]. Neither received bilateral gracilis muscle flaps as their method of reconstruction [ 5 , 11 , 12 ]. Although based on a finite number of documented cases, current evidence suggests that patients with hematological malignancies pose additional hardships in the management of Fournier’s gangrene [ 5 - 7 , 10 ].…”

“…Neither received bilateral gracilis muscle flaps as their method of reconstruction [ 5 , 11 , 12 ]. Although based on a finite number of documented cases, current evidence suggests that patients with hematological malignancies pose additional hardships in the management of Fournier’s gangrene [ 5 - 7 , 10 ]. Albasanz et al described increased rates of mortality in the population of patients with hematological malignancy [ 10 ].…”

“…Additionally, these patients may possess a higher risk of harboring nosocomial, multi-drug resistant organisms due to severe granulocytopenia [ 6 , 10 ]. Creta et al found that more serious infection with monomicrobial Pseudomonas aeruginosa was more common in those with an underlying hematological disease when compared to the general population of Fournier’s gangrene patients [ 5 ]. Though our patient had positive cultures for E. Coli .…”

“…Achieving aesthetically pleasing and functional results, we hope that this case description provides new evidence behind using this type of muscle flap to recreate the scrotal sac and will guide physicians through this method of reconstruction. In addition, we anticipate this information will contribute to the limited existing literature on patients with Fournier’s gangrene initiated by AML [ 5 , 10 ].…”