title: The spectrum of presentation and management of Fournier's gangrene--an experience of 73 cases.
abstract: OBJECTIVE
  To study the spectrum of presentation and outcome of different treatment modalities in Fournier's gangrene.
  
  
  METHODS
  It's a prospective analysis of 73 diagnosed patients of Fournier's gangrene admitted and treated in surgical department of a public sector university from June 2000 to June 2008. All patients were admitted through casualty with varying proportions of necrotizing infection of the perineal and genital fascia, with gangrene of the overlying skin. After resuscitation and preliminary investigations, including culture of the necrotic tissue, the patients were treated either conservatively by broad spectrum antibiotics, cardiopulmonary support, nutritional and fluid support or surgically by repeated aggressive wound debridement under anaesthesia. The behaviour of the disease, different modalities of treatment offered, response and outcome of the management were all collected on a proforma for statistical analysis on SPSS version 12.
  
  
  RESULTS
  Seventy three patients with a mean age of 57.32 +/- 13.87 years and range of 33-86 years presented with varying degrees of Fournier's gangrene. Of the total population, 67 (91.78%) were males and 6 (8.213%) were females. Fifty nine (80.82%) patients had one or the other co-morbidity with maximum number (n = 44, 60.2%) having diabetes mellitus. State of diabetes control was found to be an important prognostic factor. A source of infection was identified in skin, ano-rectal and perineal regions in 42 (57.53%) patients. Thirteen (17.80%) patients died despite aggressive conservative or surgical treatment.
  
  
  CONCLUSIONS
  Fournier's gangrene continues to be a lethal disease despite overall improvement in the antibiotic spectrum and surgical techniques. Diabetes remains the most important prognostic factor in the outcome of disease.
authors: Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan.
authors: Arshad Mehmood
authors: AM
authors: Malik
authors: Shiraz
authors: S
authors: Sheikh
authors: Rafique
authors: R
authors: Pathan
authors: Asad
authors: A
authors: Khan
authors: Ubedullah
authors: U
authors: Sheikh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003646:Debridement; D048909:Diabetes Complications / Q000453:epidemiology; D004926:Escherichia coli / Q000302:isolation & purification; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D018934:Fournier Gangrene / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013210:Staphylococcus / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D006442:Glycated Hemoglobin