A retrospective case series of Fournier's gangrene: necrotizing fasciitis in perineum and perianal region

Abstract

Background: To describe the clinical characteristics and management for Fournier's gangrene. Experience summary and literature references are provided for future treatment improvement.

Methods: We retrospectively reviewed the cases diagnosed with Fournier's gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier's gangrene were presented.

Results: There were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits.

Conclusions: Fournier's gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

Keywords: Fournier’s gangrene; Infection; Necrotizing fasciitis.

Fig. 1

Treatment protocols

Fig. 2

a Clinical manifestation after admission in abdomen view; b clinical manifestation in perineum view; c emergency surgical debridement was performed to control the invasive infection that involved the subcutaneous tissue and fascia, but muscle involvement was not obvious; d the excised necrotic tissue; e wound in perineum; f wound in right buttock; g repeated debridement was performed on the 5th day after admission; h wound bed manifestation after NPWT; i abdominal wound was closed by secondary suture and skin graft; j wound in right buttock was closed by secondary suture