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. 2015 May;100(5):934-41.
doi: 10.9738/INTSURG-D-15-00036.1. Epub 2015 Apr 10.

Fournier's Gangrene: A Summary of 10 Years of Clinical Experience

Abdullah Oguz  1 , Metehan Gümüş, Ahmet Turkoglu, Zübeyir Bozdağ, Burak Veli Ülger, Elif Agaçayak, Abdullah Böyük
Affiliations

Fournier's Gangrene: A Summary of 10 Years of Clinical Experience

Abdullah Oguz et al. Int Surg. 2015 May.

Abstract

We aimed to present our clinical experience with FG treatment. Fournier's gangrene (FG) is a rare but serious disease characterized by progressive necrosis in the genitourinary and perineal region. The retrospective study included 43 patients. Patients were divided into 2 groups as survivors and nonsurvivors. Included in the analysis were data pertaining to demographics, predisposing factors, comorbidities, results of bacteriologic analyses, number of debridements, duration of treatment, FG Severity Index (FGSI) score, fecal diversion methods (trephine ostomy or Flexi-Seal Fecal Management System-FMS), and dressing methods (wet or negative aspiration system). In the nonsurvivor group, urea, WBC, and age were significantly higher, whereas albumin, hematocrit, platelet count, and length of hospital stay (LOHS) were significantly lower compared to the survivor group. Mean FGSI was lower in survivors in comparison with nonsurvivors (5.00 ± 1.86 and 10.00 ± 1.27, respectively; P < 0.001). We conclude that FGSI is an important predictor in the prognosis of FG. Vacuum-assisted closure (VAC) should be performed in compliant patients in order to enhance patient comfort by reducing pain and the number of dressings. Fecal diversion should be performed as needed, preferably by using FMS. The trephine ostomy should be the method of choice in cases where an ostomy is necessary.

Keywords: Fournier's gangrene; Mortality; Trephine ostomy; Vacuum-assisted closure.

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Figures

Fig. 1
Fig. 1
Abdominal computed tomography of a patient with Fournier's gangrene. (A) Axial CT image showing bilateral abdominal wall defect, air densities on the lateral fascia (on the right), and mild thickening of the plantar fascia. (B) Axial CT image showing air densities and mild thickening of the plantar fascia at the perinial level.
Fig. 2
Fig. 2
(A) The patient with Fournier's gangrene before treatment. (B) The wound was cleaner following a second debridement and VAC. (C) Patient after wound primary closure in the operating room. (D) Surgical site at first postoperative month.
Fig. 3
Fig. 3
(A) The patient with Fournier's gangrene after debridement. (B) Patient after wound closure and skin graft.
See this image and copyright information in PMC

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