Predisposing factors and treatment outcome in Fournier's gangrene. Analysis of 28 cases.
OBJECTIVE
To evaluate the etiologic factors and the effects of surgical debridement and adjunctive therapies on morbidity and mortality of Fournier's gangrene.


METHODS
27 males, 1 female, a total of 28 patients with a mean age of 58 years treated for Fournier's gangrene were evaluated retrospectively.


RESULTS
Predisposing factors including diabetes, alcohol abuse, paraplegia and renal insufficiency were identifiable in 54% of the patients. Etiologic origin of the gangrene was urogenital, cutaneous and anorectal in 43, 25 and 11% of the patients, respectively. The pathology was limited to genitalia in 10, extending to perineum in 8, the umbilicus in 7 and even up to the axilla in 3 patients. Suprapubic cystostomy and colostomy were necessary in 18 and 2 cases, respectively. We used hyperbaric oxygen therapy in 2 and honey in 6 patients to accelerate wound healing. A repeat debridement was necessary in 39% of the cases. Plastic surgery and grafting were done in 14 patients. Our mortality rate was 7%.


CONCLUSIONS
Early recognition of the pathology and aggressive surgical debridement are the mainstay of the management of Fournier's gangrene. Additional strategies to improve wound healing and increase patient survival are also needed.
Department of Urology, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey.
Mesut
M
Gürdal
Ergin
E
Yücebas
Ali
A
Tekin
Melih
M
Beysel
Rüknettin
R
Aslan
Feridun
F
Sengör
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003646:Debridement; D005260:Female; D018934:Fournier Gangrene / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D005831:Genital Diseases, Female / Q000473:pathology; D005832:Genital Diseases, Male / Q000473:pathology; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged