[Perineal gangrene: new bacteriologic approach. Results of medico-surgical treatment (81 cases)].
OBJECTIVE
The objective of this retrospective study was to report the results of a series of 81 cases of perineal gangrene treated in the same center.


METHODS
From 1988 to 1998, 81 patients (64 males, 17 females, mean age: 58 years) with perineal gangrene were treated by a medico-surgical team, by means of a protocol combining appropriate intensive care measures based on a new bacteriologic concept of infectious agents, extensive excisions and drainage of the infraperitoneal region and hyperbaric oxygen therapy.


RESULTS
The mortality rate was 24.7%. Mean duration of intensive care stay was 19 days, mean duration of hospital stay was 31 +/- 4 days (range: 6 to 60 days). Risk factors were: age > 68 years (p = 0.001), shock (p = 0.83), subcutaneous crepitation (p = 0.25) and severity index > 10 (p = 0.003). Sequelae were anal incontinence (n = 3) and permanent colostomy (n = 5). Secondary plastic reconstruction was necessary in four patients. There were no urologic or genital sequelae.


CONCLUSIONS
Perineal gangrene is still a very serious disease. The time to treatment, the simplified severity index and consideration of bacteriologic combinations are the main prognostic factors.
Brunet
C
C
Services de chirurgie générale et urgences, département informations médicales, hôpital Sainte-Marguerite, Marseille, France.
Consentino
B
B
Barthelemy
A
A
Huart
L
L
Pirro
N
N
Cesari
B
B
Sielezneff
Y
Y
Sastre
B
B
Farisse
J
J
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D005260:Female; D005734:Gangrene; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents