Fournier's Gangrene: Necrotising Fasciitis of the Male Genitalia

Bahlmann, J.; Fourie, Izak J.v.H.; Arndt, T. C. H.

doi:10.1111/j.1464-410x.1983.tb07087.x

Cited by 51 publications

(23 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, sperm cryopreservation before rotation of the thigh fasciocutaneous flap is recommended for patients who want to have children 14 . Hyperbaric oxygen therapy is useful for the treatment of Fournier's syndrome as it removes exudates, promotes wound closure, enhances angiogenesis, and reduces bacterial contamination 1,6,8,29,30 . However, this therapy was not used in the present study because it was not available at the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…In 1884, French venereologist Jean Alfred Fournier 6 described 5 cases of patients with idiopathic gangrene of the penis and scrotum. In the original reports, Fournier describes 3 fundamental features of the clinical presentation: abrupt onset in previously healthy young men, rapid progression, and absence of a discernible cause [7][8][9][10][11] . Studies demonstrate the presence of a variety of microorganisms in cultures of wound secretions and necrotic tissues.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Síndrome de Fournier: 10 anos de avaliação

Dornelas¹,

Corrêa²,

Barra³

et al. 2012

Rev. Bras. Cir. Plást.

View full text Add to dashboard Cite

Background: Fournier's gangrene is a synergistic necrotizing fasciitis of the perineum and abdominal wall that develops in the scrotum and penis in men and the vulva and groin in women. This disease was initially believed to be idiopathic; however, recent studies have indicated that it is a serious condition caused by gram-positive, gram-negative, or anaerobic bacteria. It is often associated with severe and fatal systemic involvement. Methods: A retrospective study involving a chart review of 23 patients with Fournier's syndrome treated between January 2002 and January 2012 was conducted. Prompt treatment consisted of broad-spectrum antibiotic administration and serial debridement. The reconstruction techniques ranged from edge approximation via simple sutures to the use of flaps and grafts in cases with extensive lesions. Results: The skin and scrotal reconstruction techniques were effective in all cases, yielding satisfactory aesthetic results. Three (13%) patients died, including 2 patients who had previous illnesses and comorbidities. Conclusions: Although Fournier's syndrome is a serious disease, therapeutic measures such as prompt intervention, with early debridement and broad-spectrum antibiotic therapy, in a multidisciplinary approach is very effective for controlling the disease, enabling surgical reconstruction of the affected areas with a low mortality rate.Keywords: Fournier gangrene. Fasciitis, necrotizing. Reconstructive surgical procedures/ methods. RESUMO Introdução:A gangrena de Fournier é uma fasciite necrosante sinérgica do períneo e parede abdominal, que tem origem no escroto e pênis, no homem, e vulva e virilha, na mulher. O processo inicialmente foi descrito como idiopático, mas atualmente sabe-se que se trata de grave afecção causada por bactérias Gram positivas, Gram negativas ou anaeróbios, que pode levar a comprometimento sistêmico importante e, eventualmente, morte. Método: Foi realizado estudo retrospectivo, baseado na análise de prontuários médicos de 23 pacientes portadores de síndrome de Fournier, no período de janeiro de 2002 a janeiro de 2012. O tratamento dos pacientes incluiu intervenção precoce, com antibioticoterapia de largo espectro e desbridamentos consecutivos. O procedimento terapêutico empregado para a reconstrução variou desde a aproximação das bordas com sutura simples até uso de retalhos e enxertos, nas lesões extensas. Resultados: As técnicas de reparação cutânea foram eficientes e a reparação escrotal foi também efetiva em todos os casos, obtendo-se bons resultados estéticos. Houve 3 (13%) óbitos, 2 deles em pacientes com doenças pregressas This study was performed at the

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Síndrome de Fournier: 10 anos de avaliação

Dornelas¹,

Corrêa²,

Barra³

et al. 2012

Rev. Bras. Cir. Plást.

View full text Add to dashboard Cite

show abstract

“…The treatment is based mainly on surgical management, ranging from simple drainage to radical debridement with or without fecal or urinary diversion 2,7,25-27 , followed or not by flaps rotation 28 , use of broad spectrum antibiotics and support measures 2,29,30 . There are also adjuvant measures such as hyperbaric chamber to prevent the extension of necrosis, reduce systemic signs of infection and enhance ischemic tissue survival 31 .…”

Section: Mehl Mehl Mehl Mehl Mehlmentioning

confidence: 99%

Manejo da gangrena de Fournier: experiência de um hospital universitário de Curitiba

Mehl

Filho

Mantovani

et al. 2010

Rev. Col. Bras. Cir.

View full text Add to dashboard Cite

OBJETIVO: Analisar os resultados obtidos no Serviço de Cirurgia Geral do Hospital Universitário Cajuru - PUCPR, com o tratamento da gangrena de Fournier. MÉTODOS: Foram revisados os prontuários de 40 pacientes com diagnóstico de Gangrena de Fournier internados no hospital universitário Cajuru de Novembro de 1999 a Abril de 2006, analisando-se as variáveis: sexo, idade, fatores predisponentes, etiologia, localização da lesão, exames laboratoriais, procedimentos cirúrgicos realizados, antibioticoterapia e utilização de câmara hiperbárica. RESULTADOS: A etiologia mais comum foi de origem anorretal. O agente etiológico mais prevalente foi a E. coli. O fator predisponente predominantes foi a diabetes mellitus, A maioria dos pacientes eram do sexo masculino. A localização e extensão da lesão mais freqüente foi a perineal. Todos foram submetidos à desbridamento cirúrgico, 17 à colostomia e dois à cistostomia. Todos os pacientes utilizaram antibiótico, sendo os mais usados: metronidazol e gentamicina. Vinte e seis pacientes submeteram-se à terapia hiperbárica. A mortalidade global foi de 20%. CONCLUSÃO: A Síndrome de Fournier, apesar de todos os avanços terapêuticos atuais, continua apresentando altos índices de mortalidade. O reconhecimento precoce da infecção associado a tratamento agressivo e invasivo são medidas essenciais para se tentar diminuir esses índices prognósticos.

show abstract

“…2 Despite significant improvements in critical care, the mortality from Fournier's gangrene still remains quite high (11%-45%). 14,22,23 This can be reduced with prompt diagnosis using a high index of suspicion, aggressive surgical intervention, and broad-spectrum antibiotics.…”

Section: Discussionmentioning

confidence: 99%

A Diabetic Male With a Suprapubic Mass and Painful Penis and Scrotum

Chun¹

2006

Infectious Diseases in Clinical Practice

View full text Add to dashboard Cite

Fournier's gangrene is a life-threatening necrotizing synergistic fasciitis of the perineum, abdominal wall, and genitalia [Surg Clin North Am 2002;82:1213; Urol Clin North Am 1991;26:841]. We describe a case of a 66-year-old man whose atypical presentation posed a diagnostic and clinical challenge of such a urological emergency. Clinicians need to have a high index of suspicion for this disease in individuals with predisposing or associated conditions, given the risk for widespread extension and impact on patients' outcome. (Infect Dis Clin Pract 2006;14:65-67) CASE REPORTA 66-year-old African American male with a history of diabetes mellitus and peripheral vascular disease was admitted in December 2004 to a hospital emergency department with fever, chills, dysuria, and fluctuating blood sugars. He denied any penile discharge, unprotected intercourse, or costovertebral tenderness. He reported falling without loss of consciousness before arrival to the emergency department. Physical examination was unremarkable; there was no prostate tenderness. Values for standard laboratory tests revealed the following: white blood cell count 41 Â 1000/mm 3 , 70% neutrophils, 19% bands; urinalysis, 30 white blood cells per high-power field, negative nitrite, 2+ leukocyte esterase, moderate bacteria; sodium 133 mmol/L, potassium 3.3 mmol/L, bicarbonate 15 mmol/L, creatinine 1.1 mg/dL, lactate 2.9 mmol/L (range 0.5-2.2). No abnormalities were seen on chest radiograph and renal ultrasound.The patient was treated for a presumptive urinary infection with a fluoroquinolone. One day after discharge, the patient represented after awaking from sleep with a painful penis and scrotum and a weak interrupted urinary stream. Findings on physical examination revealed a nontoxic man with stable vital signs and a tender nonfluctuant suprapubic mass with scrotal, penile, and perineal edema. Laboratory analysis revealed white blood cell count 70.2 Â 1000/mm 3 , 86% neutrophils, 7% bands; sodium 132 mmol/L, potassium 4.0 mmol/L, bicarbonate 18 mmol/L, creatinine 0.7 mg/dL, lactate 0.7 mmol/L. Blood and urine cultures were negative. Computed tomography examination of the abdomen and pelvis demonstrated air in the subcutaneous tissue overlying the pelvis and perineum, along the fascial planes, extending halfway to the umbilicus (Fig. 1). These findings were suggestive of Fournier's gangrene.The patient was immediately taken to surgery for debridement of the perineum and corpora spongiosum. The patient was treated with intravenous imipenem and clindamycin. Wound Gram stain and culture revealed budding yeast that cultured out as Candida albicans; pathological tissue examination from the perineum revealed necrotic involvement of the skin and subcutaneous fat and fascia. Special stains for bacteria, acid-fast bacilli, and fungi were negative. The patient was taken to the operating room daily for repeated examination and debridement ultimately requiring a penectomy 21 days after initial debridement. Perineal wound vacuum cultures from 6 days after p...

show abstract

Fournier's Gangrene: Necrotising Fasciitis of the Male Genitalia

Cited by 51 publications

References 3 publications

Síndrome de Fournier: 10 anos de avaliação

Síndrome de Fournier: 10 anos de avaliação

Manejo da gangrena de Fournier: experiência de um hospital universitário de Curitiba

A Diabetic Male With a Suprapubic Mass and Painful Penis and Scrotum

Contact Info

Product

Resources

About