Fournier’s gangrene: Report of thirty‐three cases and a review of the literature

Abstract

Background: Fournier's gangrene (FG) is an extensive fulminant infection of the genitals, perineum or the abdominal wall. The aim of this study is to share our experience with the management of this difficult infectious disease. Methods: Thirty-three male patients were admitted to our clinic with the diagnosis of FG between February 1988 and December 2003. The patient's age, etiology and predisposing factors, microbiological findings, duration of hospital stay, treatment, and outcome were analyzed. The patients were divided into two groups. The first 21 patients (Group I) were treated with broadspectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning, and then they underwent split-thickness skin grafts or delayed closure as needed. The other 12 patients (Group II) were treated with unprocessed honey (20-50 mL daily) and broadspectrum triple antimicrobial therapy without debridement. Their wounds were cleaned with saline and then dressed with topical unprocessed honey. The wounds were inspected daily and the honey was reapplied after cleaning with normal saline. Then, the patients' scrotum and penis were covered with their own new scrotal skin. Results: The mean age of the patients was 53.9 ± 9.56 years (range = 23-71). The source of the gangrene was urinary in 23 patients, cutaneous in seven patients, and perirectal in three patients. The predisposing factors included diabetes mellitus for 11 patients, alcoholism for 10 patients, malnutrition for nine patients, and medical immunosuppression (chemotherapy, steroids, malignancy) for three patients. The mean duration of hospital stay was 41 ± 10.459 (range = 14-54) days. Two patients in Group I died from severe sepsis. The clinical and cosmetic results were better in Group II than Group I. Conclusions: Necrotizing fasciitis of the perineum and genitalia is a severe condition with a high morbidity and mortality. Traditionally, good management is based on aggressive debridement, broad-spectrum antibiotics, and intensive supportive care but unprocessed honey might revolutionize the treatment of this dreadful disease by reducing its cost, morbidity, and mortality.

Fournier's gangrene: a prospective study of 57 patients with special reference to validity of Fournier's gangrene severity index in predicting the outcome and mortality

“…Tissue destruction then results from a combination of ischemia and the synergistic action of various bacteria. 8,18 In our study, the mean extent of the body surface area involved in the necrotizing process was lower in patients who survived than that in those who died but, we did not find a significant difference (p = 0.067).The studies by Laor et al and Clayton et al suggested that the extent of disease was not predictive of outcome. However, in a study by Spirnak et al a greater extent of the disease was associated with a greater mortality rate for patients who had more frequent operations.…”

“…Bacteroides, and clostridia are also frequently identified. 8,19 Paty and Smith 20 reported E. coli, Bacteroides and streptococci to be the most common organisms in FG. Laor et al 11 determined the most common organisms to be E. coli and Streptococcus species.…”

“…Early clinical symptoms include redness, swelling, heat, and pain, followed by progressive pain, fever, and other symptoms of systemic toxicity (e.g., septic shock). 6,8 Risk factors include diabetes mellitus (DM), chronic alcoholism, malignant neoplasms and HIV. 9 Despite the development of knowledge regarding the etiology, diagnosis, treatment, and intensive care techniques, the mortality rate of FG is still approximately 50%.…”

Experience of 80 Cases with Fournier's Gangrene and 'Trauma' as a Trigger Factor in the Etiopathogenesis

“…[26,27] The previous reports suggested the highest incidence of male patients in the 6th decade of life. [29][30][31][32][33] Even with the lower incidence rates, the disease was found in females and in all age groups of childhood including newborn and infancy periods. [33][34][35][36][37][38][39][40] The results of the present report were in agreement with the literature regarding age and sex.…”

Honey: Antimicrobial Actions and Role in Disease Management

“…The very large body of clinical evidence for the effectiveness of honey in heaHng wounds has been reviewed [127 1 , The evidence covered in that review, plus that from trials published since the review was published [128][129][130][131][132][133][134], is from 23 randomized controlled trials involving a total of 2257 participants, seven clinical trials of other forms involving 142 participants treated with honey, four case studies where there were multiple wounds allowing comparison of honey with other treatment and 16 trials of honey on a total of 533 wounds in animal models (which rule out a placebo effect). Mostly the wounds involved were infected.…”