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Fournier's gangrene (FG) is a rare but life threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as long term alcohol misuse; however, it can also affect patients with non-obvious immune compromise. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract, or skin. FG is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the death rate remains high.
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PMID:Fournier's gangrene and its emergency management. 1689 42

Fournier's gangrene is a rare infection characterized with fast-progressing myonecrosis, that affect regions of perineum, genitalia and perianal area. This retrospective study presents authors' experiences and their principles in early diagnosis and treatment of Fournier's gangrene. The goal of this paper is to point out numerous diagnostically and therapeutic difficulties that lead to a high mortality if not recognized in time. We here describe seven male patients with myonecrosis and necrotising fasciitis in scrotal, perianal and perineal regions. Average age was 61 years (form 57 to 66 years of age), and average length of treatment was 25.8 days (from 14 to 36 days), with lethality of 14% (one case). We have recognised diabetes mellitus as risk factor, together with urethrostenosis, and other diseases of the perianal region (hemorrhoids, anal fissure, abscesses). Our hypothesis is that the key of the successful treatment is to treat as soon as symptoms onset, early and aggressive necrectomy under broad antibiotic protection. We also emphasize the possibility of recurrence of this disease even several years after treatment.
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PMID:Management of Fournier's gangrene--report of 7 cases and review of the literature. 1750 61

Fournier's gangrene (FG) describes necrotizing infections of the perineum in both sexes. Controversies in treatment of FG include the roles of orchiectomy, urinary and/or fecal diversion, and hyperbaric oxygen (HBO). Because burn centers often treat these patients, we reviewed our experience with FG during a 14-year period. With Institutional Review Board approval, we reviewed our TRACS/ABA database for patients treated for FG during 1992 to 2005. Data was recorded on demographics, preexisting medical conditions, treatment, and outcomes. Thirty patients (20 men) were identified. Mean age was 54.3 +/- 14.1 years. Predisposing conditions included diabetes in 16 patients (53%), and morbid obesity and immunosuppression in 6 each. Twenty-two patients were transferred from outside hospitals, 12 after initial surgery. Sixteen patients presented with shock (blood pressure <90/60 mm Hg). Patients underwent a mean of 4.1 surgical procedures. Ten infections penetrated the deep fascia of the perineum or abdominal wall. Suprapubic cystostomy was performed in three patients, colostomy in seven, orchiectomy in one. HBO was not used. Hospitalization averaged 25.3 +/- 15.6 days. Mean charges ($1000) were $131.5 +/- 108.3. Definitive wound closure was obtained before discharge with suture repair and/or skin grafting in 18 of 25 survivors (72%). Five patients died (17%). In logistic regression analysis, the presence of shock on admission and female gender (mortality 40%) were significantly associated with mortality. FG remains a devastating infection, which occurs primarily in compromised patients. In this series, aggressive burn center care produced outcomes equivalent to those published in other series with or without use of HBO. Colostomy and urinary diversion can be used very selectively in these patients; orchiectomy is rarely required.
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PMID:Fournier's gangrene: management at a regional burn center. 1818 22

Fournier's gangrene is a form of necrotizing fasciitis of the perineal region that frequently affects immunocompromised patients. In most cases the point of entry of the infecting microorganisms goes undetected. A case of necrotizing fasciitis was diagnosed in a 77-year-old male with diabetes mellitus following an injection of botulinum toxin in the anal sphincter to treat an anal fissure.
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PMID:Fournier's gangrene following botulinum toxin injection. 1843 37

A 44-year-old male with a history of diabetes mellitus and alcoholism for 20 years, was admitted to our hospital complaining of urinary retention and high fever. The scrotum was swollen and became necrotic partially. The inflammation and emphysema was around the anus, bilateral inguinal region, and right flank. The laboratory data showed disseminated intravascular coagulation (DIC). According to the clinical and radiological findings, we diagnosed the illness as Fournier's gangrene. Cystostomy and surgical debridment were performed in conjunction with the use of broad-spectrum antibiotics and anti-DIC therapy. After the general condition improved, the broad defect of perineal skin was covered with a free skin graft by using the negative-pressure bolster method. The graft was successful.
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PMID:[A case of Fournier's gangrene reconstructed with negative-pressure bolster for free skin grafts: a case report]. 1854 68

Fournier's gangrene (FG) is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions. Several factors have been reported to contribute to the clinical outcomes. The primary aims of this study were to examine the clinical features of patients with FG and evaluate the predictivity of the Fournier's Gangrene Severity Index (FGSI) score on the outcomes. We carried out a collective retrospective chart review of patients diagnosed and treated for FG in three reference centers between January 1995 and July 2007. Seventy-two patients with FG with were included to the study. Data were collected on medical history, symptoms, physical examination findings, admission and final laboratory tests, timing and extent of surgical debridement and antibiotic therapy. Perianal and perirectal abscess, scrotal abscess and urethral stenosis were the leading etiological factors. Diabetes mellitus was the predominant risk factor. Etiological factors and risk factors did not significantly contribute to survival or mortality, and duration of the symptoms was significantly longer in the non-survivor's group (P < 0.05). The FGSI scores were higher in the non-survivor's group. Regression analysis showed a FGSIS score of 10.5 as the cut-off to the outcome. Based on these results, we conclude that a patient's metabolic status and the extent of disease at presentation are the most important factors determining the prognosis of FG. The FGSI score may be considered as an objective and simple tool to predict the outcome in the patient with FG and should be used in further studies of FG patient series for comparison purposes.
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PMID:The clinical features of Fournier's gangrene and the predictivity of the Fournier's Gangrene Severity Index on the outcomes. 1856 18

Fournier's gangrene characterized by fulminant necrotizing fasciitis of the perineal, genital or perianal regions, is generally caused by aerobic and anareobic bacteria. Although it is thought to be an idiopathic process, Fournier's gangrene has been shown to have a predilection for patients with diabetes, long term alcohol misuse and immunocompromised patients. The focus of infection is usually located in the urinary tract, lower gastrointestinal tract or skin. The development and progression of the gangrene is often fulminating and can rapidly lead to multiple organ failures and death. Here, we present a Fournier's gangrene case caused by Candida albicans. A 59-year-old woman was admitted to hospital with the complaint of swelling on the right thigh following a trauma occurred three weeks ago. Her history revealed that she had been hospitalized previously for four times due to diabetes mellitus, essential thrombocytopenia, chronic disease anemia and hypertension. Right trochanteric fracture was detected and the patient was taken under surgical debridement with the pre-diagnosis of secondary anaerobic soft tissue infection. Empirical treatment was started with cephalosporin and metronidazole. Since wo- und and blood cultures revealed C. albicans as the primary microorganism, fluconazole was added to the therapy. However, the patient died on the post-operative 25th day because of multi-organ disfunction secondary to fungal sepsis. This case has been reported to emphasize that yeasts should be considered as pathogenic agents in diabetic patients with gangrene.
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PMID:[Fournier's gangrene caused by Candida albicans]. 1914 96

Fournier's gangrene is a rapidly progressive necrotizing fasciitis of the perineum and external-genital organs. It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with a synergistic action. The aetiology is identified in 95% of cases. The source of infection is either cutaneous, urogenital or colorectal. Predisposing factors, such as age, diabetes and immunodepression, are often present in affected patients. Urgent and aggressive treatment is essential to ensure the patient's survival. Treatment consists of restoration of the fluid and electrolyte balance and broad-spectrum antibiotic therapy rapidly followed by surgical debridement. However, the mortality remains high, about 20 to 80%, frequently, due to delayed diagnosis and management. Patients who survive the infection require reconstructive surgery with sometimes marked sequelae related to the extent of fasciitis and debridement.
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PMID:[Fournier's gangrene: a review of the recent literature]. 1916 9

Fournier's gangrene is a rare disease of rapidly progressive necrotising fasciitis of the genital, perineal and perianal regions and leads to sepsis and death. We report 8 cases of Fournier's gangrene treated at our hospital and affiliated hospitals from 1997 to 2007. There were seven males and one female in the series, and the age range was 23-89 years (mean age 56.6 years). Four patients among them had diabetes mellitus. We rescued all patients by broad-spectrum antibacterial chemotherapy and debridement. Good management should be based on broad-spectrum antibacterial chemotherapy, debridement and intensive care.
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PMID:[Experience in the treatment of eight cases of Fournier's gangrene]. 1982 15

Fournier's gangrene (FG) is a rare form of the skin and subcutaneous tissue bacterial infection characterized clinically by rapid progression and significant mortality, patohistologically by extensive necrosis of supeficial and deep facial planes and epidemiologically by predilection to patients with diabetes, immunosupression, malignant diseases or other debilitating state. In our retrospective study, we analyze 17 patients with FG hospitalised in our hospital in the 16-year period. Mean age of the patients was 58.9, and female-to-male ratio was 1:16. Among the predisposing factors diabetes mellitus (41.2%) and malignant diseases (29.4%) were the most common. Average length of hospital stay was 36 days (2-81) with lethality of 41.2% (7 patients). We assessed no statistical significance of the analysed prognostic parameters. In conclusion, we emphasize that FG is a surgical emergency and we express our impression that lack of physicians' experience is the main factor leading to delay in diagnosis and treatment of this rare, but life threatening disease.
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PMID:[Fournier's gangrene--our experience with 17 patients]. 2054 Apr 34


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