Prognostic factors and treatment outcomes for patients with Fournier's gangrene: a retrospective study

Abstract

Fournier's gangrene is a gas-forming, necrotising soft tissue infection affecting the perineum. It spreads rapidly along the deep fascial planes and is associated with a high mortality rate. With a growing elderly population with comorbidities, the frequency of severe cases of Fournier's gangrene is expected to increase. We retrospectively reviewed 20 patients diagnosed with Fournier's gangrene at our institution from 2003 to 2014 and analysed data. Thirteen patients had diabetes mellitus, two had been diagnosed with liver cirrhosis, and four were chronic alcoholics. Of 15 patients admitted to an intensive care unit, 11 underwent colostomy, and 4 required skin grafts for wound healing. The wide wounds of two patients were healed using vacuum-assisted closure (VAC ) dressing without additional surgery. The mortality rate was 25%, and the patients whose Fournier's gangrene severity index (FGSI) score was higher than 9 points or whose blood urea nitrogen (BUN) level was higher than 50 mg/dl had a poor prognosis. In order to treat Fournier's gangrene, aggressive surgical treatment, including wide debridement and stoma creation, should be considered as soon as possible to improve survival rates. Additionally, VAC dressing is helpful in healing the wide debridement wound without additional reconstructive surgery.

Bilateral femoral posterior neurocutaneous perforater flap successfully treating Fournier gangrene

“…FC is a rare disease in clinic and it is tough to cure. Recent researches [ 5 ] have shown that aggressive surgical treatment including wide debridement and VSD should be considered as soon as possible to struggle for a better chance for reconstructive surgery. Mizuguchi et al [ 13 ] reported a case on negative-pressure wound therapy successfully treating NF after rectal surgery.…”

“…Young and Aronoff [ 3 ] reviewed literature on NF and found that rate of NF in extremities was higher than that in central areas. Previous studies [ 4 , 5 ] reported that the risk factors for NF were diabetes, trauma, wound infections, decubitus ulcers, alcoholism, carcinoma, peripheral vascular disease, smoking, and intravenous drug abuse. NF could be infected by various kind of bacteria.…”

The diagnosis and management of Fournier's gangrene

“…Low albumin, an indicator of synthetic liver failure, has shown a trend toward worse prognosis. 8 However, alcoholism appears to have no bearing on outcome. 2,8 Causative organisms…”

“…Commonly found organisms include Staphylococcus aureus, Streptococcus species, Escherichia coli and Acinetobacter. 6,8,13 In this regard, antibiotic resistance may be a growing concern in Fournier's gangrene with methicillin-resistant Staphylococcus aureus (MRSA) being the most commonly cultured resistant organism. 15 Patients with multiple drug resistant organisms have shown a trend towards having poorer outcomes.…”

Negative pressure wound therapy and split thickness skin graft aided in the healing of extensive perineum necrotizing fasciitis without faecal diversion: a case report

“…Due to the rapid progression of the disease, an early diagnosis of FG is vital to identify the need to start appropriate treatment. The principles of management are achieving haemodynamic stability, the use of broad-spectrum antibiotics, prompt surgical debridement, and the positive prevention of complications [ 3 , 4 ]. Some studies have shown that NPWT can secure STSGs and improve graft survival in the treatment of FG [ 5 ].…”