title: Case series of Fournier's gangrene: Affected body surface area - The underestimated prognostic factor.
abstract: OBJECTIVE
  Identifying the factors affecting the outcome of patients with Fournier's Gangrene and assaying the accuracy of the Fournier Gangrene Severity Index (FGIS), the Uludag score (UdS), affected Body Surface Area (BSA) and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) model as prognostic tools.
  
  
  METHODS
  Retrospective study involving all patients with Fournier's gangrene treated in our Hospital between January 2008 and December 2015. The epidemiological, clinical, biochemical and management data of these patients was obtained and analyzed.
  
  
  RESULTS
  The series includes 19 patients, 14 male and 5 female, with a median age of 70 (62; 78,5) years. The mortality rate was 21%. From the data analyzed, only the affected BSA (BSA>3.25%) was associated with mortality (p = 0.016). None of the established scores (FGSI; UdS; LRINEC) proved to be a useful tool for predicting mortality. The combination of affected BSA and FSGI (FGSI≥9 or BSA>3.25%), (p = 0.004) and the combination of the affected BSA and the LRINEC model (LRICEC≥8 and BSA>3.25%), (p = 0.004) led to a major improvement in these scores.
  
  
  CONCLUSIONS
  Affected BSA is a useful prognostic factor in Fournier's gangrene. The existing prognostic scores can be improved with the introduction of this factor.
authors.affiliation: Department of Surgery, Hospital Distrital da Figueira da Foz, 3094-001, Figueira da Foz, Portugal.
authors.forename: Henrique
authors.initials: H
authors.lastname: Morais
authors.affiliation: Department of Surgery, Hospital Distrital da Figueira da Foz, 3094-001, Figueira da Foz, Portugal.
authors.forename: Jessica
authors.initials: J
authors.lastname: Neves
authors.affiliation: Department of Surgery, Hospital Distrital da Figueira da Foz, 3094-001, Figueira da Foz, Portugal.
authors.forename: Hugo
authors.initials: H
authors.lastname: Maciel Ribeiro
authors.affiliation: Department of Surgery, Hospital Distrital da Figueira da Foz, 3094-001, Figueira da Foz, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Ferreira
authors.affiliation: Department of Surgery, Hospital Distrital da Figueira da Foz, 3094-001, Figueira da Foz, Portugal.
authors.forename: Narcisa
authors.initials: N
authors.lastname: Guimarães
authors.affiliation: Department of Surgery, Hospital Distrital da Figueira da Foz, 3094-001, Figueira da Foz, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Azenha
authors.affiliation: Department of Surgery, Hospital Distrital da Figueira da Foz, 3094-001, Figueira da Foz, Portugal.
authors.forename: Raquel
authors.initials: R
authors.lastname: Dias
authors.affiliation: Department of Surgery, Hospital Distrital da Figueira da Foz, 3094-001, Figueira da Foz, Portugal.
authors.forename: Alice
authors.initials: A
authors.lastname: Fonseca
authors.affiliation: Department of Surgery, Hospital Distrital da Figueira da Foz, 3094-001, Figueira da Foz, Portugal.
authors.forename: Lucilia
authors.initials: L
authors.lastname: Conceição
keywords: Fournier's gangrene; Predicting scores; Prognostic factors