[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.
Services de chirurgie générale et urgences, département informations médicales, hôpital Sainte-Marguerite, Marseille, France.
C
C
Brunet
B
B
Consentino
A
A
Barthelemy
L
L
Huart
N
N
Pirro
B
B
Cesari
Y
Y
Sielezneff
B
B
Sastre
J
J
Farisse
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