The management of Fournier?s gangrene: A review of 60 patients

Abstract

Salih Onur Basat,Tumay Ipekci, Fatih Ceran, Mehmet Kisaarslan, Mehmet Bozkurt

Background: Fournier’s gangrene (FG) is a rapidly progressive, destructive, necrotizing fasciitis of the perianal, perineal, and genital regions. Common clinical symptoms include sudden intense pain in the scrotum, prostration, fever, and pallor. In this study, the aim was to assess FG through a wider lens. Methods: 60 patients that presented with FG at the authors’ hospital over a 6-year period between April 2008 and March 2014 were retrospectively reviewed. Age, gender, site of gangrene, risk factors, symptoms, microbiology, treatment modalities, Fournier’s Gangrene Severity Index score (FGSI), and mortality data were evaluated. Results: 60 male patients with a mean age of 55 (ranging between 48-62) were included in the study. 50 patients survived and the mortality rate was 16.6%. Septic shock (n: 4), cardiogenic shock (n:4), and pneumonia (n:2) were the official causes of death. As a risk factor, 45 (75%) patients had diabetes mellitus (DM), 40 (66.6%) had hypertension (HT), and 35 (58.3%) had both DM and HT. There were no other co-morbidities in the 10 (16.6%) remaining patients. All the surviving 50 patients were suitable for surgical reconstruction. A split thickness skin grafting procedure was performed for 46 (76.6%) patients and flap reconstruction was performed for 4 (6.6%). None of the patients had hyperbaric oxygen therapy (HBO). The mean length of hospitalization was 16 days (ranging from 5-58) for all patients. A mean FGSI score at admission was 5.02 ± 2.45 for survivors compared with 13.8 ± 4.53 for non-survivors. A mean FGSI score was 4.56 ± 2.28 for survivors and 11.50 ± 2.63 for non-survivors during hospitalization. Conclusion: Although FG has a high mortality rate, appropriate management of the disease can reduce it. Early diagnosis, surgical debridement, vacuum-assisted closure application, and antibiotherapy are essentials for treating FG. Key words: Fournier’s Gangrene, VAC, therapy, review 1 Department of Plastic, Reconstructive and Aesthetic Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey 2 Department of Urology, Baskent University Alanya Practice and Research Hospital, Antalya, Turkey 3 Department of Urology, Akdeniz University Medical Faculty, Antalya, Turkey Salih Onur Basat, MD, Department of Plastic, Reconstructive and Aesthetic Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey. e-mail: sabasat@hotmail.com October 15, 2014 / December 27, 2015 Author affiliations : Correspondence : Received / Accepted : 1 Bauru Dental School University of São Paulo Bauru–SP, Brazil 2 Araraquara Dental School São Paulo State University Araraquara-SP, Brazil Received: February 05, 2012 Accepted: February 29, 2012 Arch Clin Exp Surg 2012;X: X-X DOI: 10.5455/aces.20120229052919 Corresponding author Érica Dorigatti de Avila Departamento de Estomatologia da Faculdade de Odontologia de Bauru Universidade de São Paulo (USP) Avenida Alameda Octávio Pinheiro Brizola, 9-75, 17012-901 Bauru–SP, Brasil erica.fobusp@yahoo.com.br Original Article Increased of Langerhans Cells in Smokeless Tobacco-Associated Oral Mucosal Lesions É