[Skin gangrene of the external genitalia. Report of 44 cases].
OBJECTIVE
The aim of this study is to report 44 cases of male external genitalia cutaneous gangrene which have been observed at the Principal Hospital of Dakar (Senegal) during a 4-year period.


METHODS
The patients all belonged to a black and poor population (mean age: 60 years). Diabetes was present in 11% of the patients. In ten patients, no aetiology was found. The other 34 cases were secondary mainly to urogenital pathology (50%). In 50% of the cases, the lesions were localised on the external genitalia, in the other 50%, the lesions had spread to the hypogastrium and/or the perineum. Medical treatment included intensive care and triple antibiotic therapy, penicillin, gentamycin and metronidazole. A hyperbaric oxygen therapy was associated in 25% of the cases. The surgical treatment in the acute period included incising, debridement, paring, draining, urinary derivation (n = 36), and colostomy (n = 5). Thirteen patients had the benefit of sequential and prospective bacteriological tests.


RESULTS
Spontaneous healing was obtained in 48% of the patients within 2 to 3 months. Secondary reconstructive surgery consisted mainly in cutaneous grafts. Global mortality rate was 34%, mortality rate was 30% in the secondary gangrenes, 40% in the primitive gangrenes. Mean hospitalisation duration was 6 weeks. Main sequelae were cheiloïd scars.


CONCLUSIONS
The authors try to clarify the nosological imprecisions of this pathology by distinguishing between the secondary types and the primitive types corresponding to Fournier's gangrene, which still inspires many questions concerning its etio-pathogenesis. The surgical treatment must eradicate all necrosis by suited iterative procedures, associated with local care. Hyperbaric oxygen therapy was not efficient in this series. This pathology, although rare, needs to be better known, because only an early and efficient surgical and medical treatment will be able to decrease the exceptional gravity of the prognosis.
Brissiaud
J C
JC
Service de chirurgie viscérale, hôpital d'instruction des Armées Desgenettes, Lyon, France.
Azam
P
P
Paret
B
B
Lopy
J
J
Louis
C
C
Collet
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018934:Fournier Gangrene / Q000175:diagnosis / Q000628:therapy; D005832:Genital Diseases, Male / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
Gangrène cutanée des organes génitaux externes. A propos de 44 cas.