title: Fournier gangrene: a review of 41 patients and strategies for reconstruction.
abstract: Fournier gangrene is an acute and potentially fatal infection of the scrotum, perineum, and abdominal wall. It is characterized by necrotizing fasciitis with loss of subcutaneous tissue and skin. The aim of this study was to analyze the prognosis and treatment effectiveness of this fulminant infectious disease. Forty-one patients were admitted to our hospital with the diagnosis of Fournier gangrene between January 1998 and December 2006. The patients' age, sex, predisposing factors, duration of symptoms and hospital stay, time to operation, size of the skin defect, bacteria isolated, treatment modalities, and outcomes were reviewed. The data were analyzed by chi2 analysis and Student t test. A P-value <0.05 was considered significant. The mean age of the patients was 57.2 years. The most common predisposing factor was diabetes mellitus in 21 patients (51.2%), followed by cirrhosis of the liver, uremia, alcoholism, and underlying malignancy. The most common symptoms were fever (87.8%) and pain or swelling over the genital region (85.4%). The initial treatment included extensive debridement and open drainage. Time to operation ranged from 1 to 10 days. Reconstructive surgery was performed for 22 patients. The mortality rate was 19.5%. Delayed debridement was a significant factor affecting the survival rate. Our study is a retrospective study of patients with Fournier gangrene undergoing debridement and reconstructive procedure. Because of the fulminant course of Fournier gangrene, it may be difficult to design a prospective study. Fournier gangrene is a severe infectious disease with a high mortality rate. Early and aggressive debridement is a significant prognostic factor in the management of Fournier gangrene. Several reconstructive modalities are useful to correct the tissue defect. Early debridement and reconstructive surgery for wound coverage improve the quality of life.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
authors.forename: Shih-Yi
authors.initials: SY
authors.lastname: Chen
authors.forename: Ju-Peng
authors.initials: JP
authors.lastname: Fu
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Wang
authors.forename: Tzu-Peng
authors.initials: TP
authors.lastname: Lee
authors.forename: Shyi-Gen
authors.initials: SG
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018934:Fournier Gangrene / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D006084:Graft Rejection; D006085:Graft Survival; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012611:Scrotum / Q000382:microbiology / Q000601:surgery*; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents