title: Is intensive multimodality therapy the best treatment for fournier gangrene? Evaluation of clinical outcome and survival rate of 41 patients.
abstract: BACKGROUND
  To evaluate the effect of surgical wound debridement, antibiotics, and hyperbaric oxygen (HBO) in the treatment of Fournier gangrene (FG).
  
  
  METHODS
  Forty-one patients with a mean age of 54.3±14.6 years were referred to our department with a diagnosis of FG. To calculate a Fourier Gangrene Severity Index (FGSI), nine factors were assessed (temperature; heart rate; ventilatory rate; serum sodium, potassium, creatinine, and bicarbonate concentrations; hematocrit; and leukocyte count). After clinical stabilization, extensive debridement of the necrotic tissue was performed, and a surgical vacuum-assisted closure (V.A.C.®) device was applied. Hyperbaric oxygen was administered; medical therapy consisted of intravenous antibiotics, electrolyte replacement, and parenteral nutrition.
  
  
  RESULTS
  Intraoperative cultures revealed Escherichia coli in 27 patients (66%), Pseudomonas aeruginosa in 28 (68%), gram-positive cocci in 24 (59%), and mixed flora (aerobic and anaerobic bacteria) in 39 (95%). One month after primary debridement, wound granulation was sufficient for plastic surgical reconstruction in all patients.
  
  
  CONCLUSIONS
  Because of the rapid worsening of FG, early diagnosis and immediate, aggressive multi-modality therapy with surgical debridement and broad-spectrum empiric antibiotics is crucial. The utility of HBO remains unproved.
authors.affiliation: Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle/Saale, Germany.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Wagner
authors.forename: Francesco
authors.initials: F
authors.lastname: Greco
authors.forename: M Raschid
authors.initials: MR
authors.lastname: Hoda
authors.forename: Felix
authors.initials: F
authors.lastname: Kawan
authors.forename: Hans
authors.initials: H
authors.lastname: Heynemann
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D060085:Coinfection / Q000382:microbiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D003646:Debridement; D004927:Escherichia coli Infections / Q000382:microbiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D018934:Fournier Gangrene / Q000382:microbiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000382:microbiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents