FOURNIER’S GANGRENE – SURGICAL CONSIDERATIONS

  • Alin Vasilescu First Surgical Clinic, Saint Spiridon University Hospital, Iași, Romania & ”Grigore T Popa” University of Medicine and Pharmacy, Iași, Romania
  • Eugen Târcoveanu First Surgical Clinic, Saint Spiridon University Hospital, Iași, Romania & ”Grigore T Popa” University of Medicine and Pharmacy, Iași, Romania
  • Cristian Lupașcu First Surgical Clinic, Saint Spiridon University Hospital, Iași, Romania & ”Grigore T Popa” University of Medicine and Pharmacy, Iași, Romania
  • Costel Bradea First Surgical Clinic, Saint Spiridon University Hospital, Iași, Romania & ”Grigore T Popa” University of Medicine and Pharmacy, Iași, Romania
Keywords: Fournier’s gangrene, necrotizing fasciitis, surgical debridement

Abstract

Fournier’s gangrene (FG) is a galloping form of necrotizing infectious fasciitis located in the perineal, genital or perianal regions. Methods: The medical records of 10 patients with FG between 01 January 2003 to 31 January 2020 who presented in the Emergency Department at the St. Spiridon University Hospital Iasi were reviewed retrospectively. Results: All patients were males, with a mean age 51 years (range 24 years–78 years). One of the most common predisposing factors was diabetes. The mean time of symptoms prior to referral to treatment was 11 days, ranging from 4 days to 25 days. We performed a radical surgical debridement, requiring up to 5 surgical interventions consisted of excision of all necrotic tissue. In 3 patients (30%) after initial radical debridement, underwent loop colostomy for fecal diversion. Orchiectomy was performed unilaterally for gangrenous testis in one case. We registered mortality in 2 cases with FG extended to the abdominal wall. Conclusions: FG is still a fulminant disease, with a high mortality rate and prolonged hospitalization. Prognostic factors for mortality are advanced age, renal failure, extension to the abdominal wall, septic shock, and postoperative mechanical ventilation. Early diagnosis and aggressive treatment are essential for a good prognosis.

References

[1] Insua-Pereira I, Ferreira PC, Teixeira S, Barreiro D, Silva Á. Fournier's gangrene: a review of reconstructive options. Cent European J Urol. 2020;73(1):74-79.
[2] Gadler T, Huey S, Hunt K. Recognizing Fournier's Gangrene in the Emergency Department. Adv Emerg Nurs J. 2019 Jan/Mar;41(1):33-38.
[3] Short B. Fournier gangrene: an historical reappraisal Intern Med J. 2018 Sep;48(9):1157-1160.
[4] Fournier JA. Gangrene foudroyante de la verge. Sem Méd. 1883;4:589–97.
[5] CNN.com – Health (25 January 2002). Mystery of Herod's death 'solved' CNN Archives, 2002.
[6] Eke N, Raphael JE. Fournier’s Gangrene in Vitin A ed. Gangrene. Current Concepts and Management Options. InTechOpen, 2011. ISBN: 978-953-307-386-6
[7] Talwar A, Puri N, Singh M. Fournier's Gangrene of the Penis: A Rare Entity. J Cutan Aesthet Surg. 2010;3(1):41-44. doi:10.4103/0974-2077.63394
[8] Norton KS, Johnson LW, Perry T, Perry KH, Sehon JK, Zibari GB. Management of Fournier's gangrene: an eleven-year retrospective analysis of early recognition, diagnosis, and treatment. Am Surg. 2002 Aug;68(8):709-13.
[9] Overholt T, Hajiran A, Ueno C, Zaslau S. Fournier's Gangrene of the Penis following a Human Bite Wound. Case Rep Urol. 2018 Oct 25;2018:9798607.
[10] Singh A, Ahmed K, Aydin A, Khan MS, Dasgupta P. Fournier's gangrene. A clinical review. Arch Ital Urol Androl. 2016 Oct 5;88(3):157-164.
[11] Bakshi C, Banavali S, Lokeshwar N, et al. Clustering of Fournier (male genital) gangrene cases in a pediatric cancer ward. Med Pediatr Oncol. 2003;41(5):472–74.
[12] Kuzaka B, Wróblewska MM, Borkowski T, et al. Fournier's Gangrene: Clinical Presentation of 13 Cases. Med Sci Monit. 2018;24:548-555.
[13] Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, Baspinar I. Fournier's gangrene: risk factors and strategies for management. World J Surg. 2006 Sep;30(9):1750-4.
[14] Ferrer O E. Fournier’s Gangrene – Medical and Surgical Considerations in Vitin A ed. Gangrene. Current Concepts and Management Options. InTechOpen, 2011. ISBN: 978-953-307-386-6
[15] Aridogan IA, Izol V, Abat D, et al. Epidemiological characteristics of Fournier’s gangrene: A report of 71 patients. Urol Int. 2012;89(4):457–61.
[16] Mallikarjuna MN, Vijayakumar A, Patil VS, Shivswamy BS. Fournier’s gangrene: Current practices. ISRN Surg. 2012;2012:942437.
[17] Palvolgyi R, Kaji AH, Valeriano J, Plurad D, Rajfer J, de Virgilio C. Fournier's gangrene: a model for early prediction. Am Surg. 2014 Oct;80(10):926-31.
[18] Levenson RB, Singh AK, Novelline RA. Fournier gangrene: role of imaging. Radiographics. 2008 Mar-Apr;28(2):519-28.
[19] Iacovelli V, Cipriani C, Sandri M, Filippone R, Ferracci A, Micali S, Rocco B, Puliatti S, Ferrarese P, Benedetto G, Minervini A, Cocci A, Pastore AL, Al Salhi Y, Antonelli A, Morena T, Volpe A, Poletti F, Celia A, Zeccolini G, Leonardo C, Proietti F, Finazzi Agrò E, Bove P. The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER'S gangrene: a retrospective multi-institutional cohort study. World J Urol. 2020 Mar 31:1–8.
[20] Ozkan OF, Koksal N, Altinli E, Celik A, Uzun MA, Cıkman O, Akbas A, Ergun E, Kiraz HA, Karaayvaz M. Fournier's gangrene current approaches. Int Wound J. 2016 Oct;13(5):713-6.
[21] Doluoglu OG. Editorial Comment to Incorporating Simplified Fournier's Gangrene Severity Index with early surgical intervention can maximize survival in high-risk Fournier's gangrene patients. Int J Urol. 2019 Jul;26(7):743-744.
[22] Verma S, Sayana A, Kala S, Rai S. Evaluation of the Utility of the Fournier's Gangrene Severity Index in the Management of Fournier's Gangrene in North India: A Multicentre Retrospective Study. J Cutan Aesthet Surg. 2012;5(4):273-276.
Published
2022-11-23