Summary Background Fournier’s gangrene is an acute and potentially lethal necrotising fasciitis that involves the scrotum and perineum. This disease can result in the loss of skin and soft tissue. To ...repair the scrotal and perineal defects remains a surgical challenge. Methods Between January 2000 and December 2008, 50 patients were admitted to our hospital with a diagnosis of Fournier’s gangrene. We retrospectively reviewed 31 of the 44 surviving patients, who needed reconstructive procedures for coverage of scrotal and perineal soft-tissue defects. The choice of reconstructive procedure was based on the size, location, severity of the defects and the availability of local tissue. The patients’ age, predisposing factors, defect size and location, reconstructive procedures and outcomes were reviewed. Results The mean age of the patients was 53.6 years (range, 20–84 years). The average size of the skin defect was 86 cm2 . A total of 12 patients were treated by scrotal advancement flap coverage, nine by split-thickness skin graft, five by pudendal thigh flap, two by gracilis myocutaneous flap, one by gracilis muscle flap plus split-thickness skin graft and three by pedicle anterolateral thigh flap. The overall surgical complication rate was 16%. Conclusions Early debridement and wound coverage in Fournier’s gangrene are mandatory to allow patients to return to normal life. We set up a valuable reconstructive algorithm based on the characteristics of the defects and our 9 years of experience, which adds to the versatility of the armamentarium of the reconstructive surgeon.
A supralevator anorectal abscess may lead to a rare clinical complication, such as perineal necrotizing fasciitis. A 57-year-old man was admitted on an emergency basis with evidence of a deep ...anorectal abscess of 5-day duration. The clinical presentation involved an unbounded purulent destructive inflammation spreading onto the adjacent areas, with the development of a septic condition. Following a short preparation, a radical surgical debridement of a subfascial purulent necrotic phlegmon of the pelvic space was performed. Since the lower part of the abdomen, retroperitoneum and scrotum were involved, 4 additional subsequent necrectomies were performed at 48-hour intervals. The aggressive radical operative treatment and the combined intensive therapy were the main contributors to the favorable outcome of the disease.
Fournier's gangrene (FG) is a life-threatening infection of the perineal and genital areas. We examined the comorbid diseases, treatments and factors affecting mortality in FG.
This retrospective ...clinical study involved 52 patients who were treated for FG. The demographics, aetiologies, comorbid diseases, laboratory and bacteriology findings, treatment methods and length of hospital stay were compared between patients who died and those who survived the infection.
Out of the 52 patients, 12 died and 40 survived. Patients who died and those who survived were similar in terms of their mean age at first presentation (62 vs. 55 years), the mean number of debridements (3.6 vs. 2.9), the mean length of hospital stay (25 vs. 34 days) and gender (p > 0.05 for each). However, the mean leukocyte count was higher in patients who died than in surviving patients (33.6 ± 7.2 vs. 14.3 ± 4.9 cells/mml; p < 0.05). The most common aetiology in both groups was perianal abscess. Deviating colostomy was performed in 13 patients. Of the patients who died, nine had haemodialysis-dependent chronic renal failure and type II diabetes mellitus (DM), while one had type II DM and hypertension.
Haemodialysis-dependent chronic renal failure and a high leukocyte count at first presentation were found to be the factors affecting mortality in FG patients.
Necrotizing fasciitis is a deep soft tissue infection that causes progressive destruction of the muscle fascia and subcutaneous . One of its presentations is Fournier's Gangrene (FG) for which the ...diagnosis must be accurate and associated with early surgical debridement and broad-spectrum antibiotic therapy. If management is delayed, the impact on prognosis is negative. Current treatment options include a technique to improve cleaning and granulation of the cruciate area using a technological device and the vacuum assisted closure system (VAC).
We describe a handmade technique of VAC therapy implemented in a series of cases of male patients diagnosed with FG, in response to the scarce economic resources of patients who are generally affected in our environment; proposing a more economical, safe and replicable option for our environment.
La fascitis necrosante es una infección de los tejidos blandos profundos que provoca la destrucción progresiva de la fascia muscular y subcutánea. Una de sus presentaciones es la Gangrena de Fournier (GF) para el cual el diagnóstico debe de ser preciso y asociado a desbridamiento quirúrgico precoz y antibioticoterapia de amplio espectro. Si existe retraso del manejo, la repercusión en el pronóstico es negativa. Entre las opciones actuales para el tratamiento destaca una técnica para mejorar la limpieza y granulación del área cruenta mediante el uso del dispositivo tecnológico y el sistema de cierre asistido por vacío (VAC).
Describimos el manejo y la técnica de la terapia VAC implementado artesanalmente en una serie de casos de pacientes masculinos con diagnóstico de GF, en respuesta a los escasos recursos económicos de los pacientes que generalmente son afectados en nuestro medio; proponiendo una opción más económica, segura y replicable para nuestro entorno
Fournier's gangrene is a urological emergency, comprising of type I necrotizing fasciitis resulting in anatomic defects affecting the perineum, perianal region, and external genitalia in both men and ...women, often requiring reconstruction.
The aim of this article is to provide a comprehensive review of the different reconstructive techniques for Fournier's gangrene.
A literature search was performed on PubMed with the search terms "Fournier"s gangrene" "genital reconstruction" and "Fournier's gangrene phalloplasty." The European Association of Urology's guidelines on Urological infections were also consulted for recommendations.
Reconstructive procedures include primary closure, scrotal advancement flaps, fasciocutaneous flaps, myocutaneous flaps, skin grafts, and phalloplasty. There is insufficient evidence to support that flaps lead to better outcomes than skin grafts, or vice versa, particularly for scrotal defects. Both techniques have been shown to have satisfactory aesthetic results, with good skin color match and natural scrotal contour. With regards to phalloplasty, there is a lack of data specifically relating to Fournier's gangrene, as most articles were addressed toward gender affirmation surgery. Furthermore, there is a lack of guidelines in both the immediate and reconstructive management of Fournier's gangrene. Lastly, the outcomes reported following reconstructive surgery have been objective rather than subjective, meaning that patient satisfaction was rarely recorded.
Further research is required in the field of reconstructive surgery specific to Fournier's gangrene, which should also take into consideration patient demographics and subjective reports regarding cosmesis and sexual function.
Fournier's Gangrene (FG) is the necrotizing fasciitis of the perineal region.
To compare the effectiveness of debridement alone and debridement with vacuum-assisted closure in the treatment of ...Fournier's gangrene.
Twenty-two patients operated for FG were analyzed retrospectively. Debridement-only and debridement + VAC treatment groups were compared in terms of age, gender, predisposing factors, comorbid diseases, intensive care unit and hospital stay durations, laboratory results, septic shock, treatment methods, Fournier' gangrene severity index (FGSI) and mortality.
The M/F ratio was 13/9. There were 10 and 12 patients in debridement-only and debridement + VAC groups, respectively. Ten patients (45.5%) were admitted to intensive care unit, 8 (36.4%) needed colostomy and 7 (31.9%) developed septic shock, respectively. The mortality rate was 27.3%. There was no significant difference in terms of age, gender, laboratory parameters, number of debridement, length of stay in intensive care unit and hospital, shock duration, and mortality (P > 0.05). The FGSI scores also did not show any difference between the groups which showed that the severity of the disease in both groups are similar.
The VAC treatment was found not to provide a statistically significant benefit on mortality. Early and adequate debridement and antibiotic are still the most important factors in the treatment of FG and to reduce mortality.
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