[Fournier's gangrene involving all of the scrotum: treatment by multiple repeated surgical excisions, diversion colostomy, triple antibiotic therapy and postoperative intensive care].
OBJECTIVE
To describe and analyse the proposed therapeutic modalities to treat a series of patients suffering from Fournier's gangrene involving the entire scrotum.


METHODS
Four patients with macroscopically identical lesions of Fournier's gangrene involving the entire scrotum were managed by wide surgical debridement, diversion colostomy, triple combination antibiotic therapy, transfer to surgical intensive care, multiple repeated operations under general anaesthesia for excision of atonic tissues and mesh skin grafts. The colostomy was closed after 4 months.


RESULTS
All patients survived after skin cover. Three of them were reviewed 2 months after restoration of gastrointestinal continuity and presented a good general status with a satisfactory esthetic result. The fourth patient was lost to follow-up. The mean reoperation rate was 6.5 per patient. The mean intensive care stay was 9.5 weeks.


CONCLUSIONS
The choice of intensive treatment depends on the extent of the lesions. When the entire scrotum is involved, repeated surgical excisions and systematic colostomy, combined with the other treatment modalities appear to be necessary to manage this disease, which still has a serious prognosis.
Méjean
A
A
Service d'Urologie, Hôpital Necker, Paris, France.
Codet
Y P
YP
Vogt
B
B
Cazalaa
J B
JB
Chrétien
Y
Y
Dufour
B
B
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003125:Colostomy; D003422:Critical Care; D005500:Follow-Up Studies; D018934:Fournier Gangrene / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005832:Genital Diseases, Male / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D012611:Scrotum; D013997:Time Factors
D000900:Anti-Bacterial Agents