Fournier Gangrene: our treatment experience
Article published in Urologia Polska 2008/61/1.

authors

Alexander Shuliak, Alexander Stroy, Iryna Shatynska, Yulyan Mytsyk, Rostyslav Telefanko

Lviv National Medical University named after Danylo Halytskyi, Ukraine

keywords

Fournier Gangrene, treatment

summary

Materials and methods. The authors have studied the course, complications and long-term results after the treatment of 13 cases of FG that occurred between 1982 and 2007. The severity of the disease was measured using the Fournier Severity Index (FSI, suggested by Laor et al.), which included evaluation of physical data, laboratory values, ultrasonography, tomography and radiological findings. Surgical treatment was retrospectively studied and analysis of patient records was performed. The average duration of treatment was 1,5 months.

Results. 7 patients were admitted in the first hours after onset, 4 patients were admitted between 6-8 hours from onset and 2 patients sought medical aid 24 hours after onset. The average FSI was 9.1 (ranging from 0 to 15). The average FSI of survivors was 8.6, and the mean FSI of the demised patients was 12.4. Inspection revealed that in 6 cases only scrotum was involved with minor involvement of adjacent tissues (Fig. 3), in 4 cases penis was affected, in 2 cases the anterior abdominal wall was involved and in 1 case the inner surface of the thigh was compromised. The lethality was 3 patients of 13.

Conclusions. 1.Fournier gangrene is a very dangerous infectious condition with fulminant course that requires immediate surgical intervention in combination with therapy by potent broad-spectrum antibiotics. 2.The prognostic likelihood of a lethal outcome is proportional to the area of lesion, time from onset to hospitalization, promptness and radicalism of surgical treatment, which should be performed according to the criteria developed by the authors. 3.Surgical treatment should be radical in its nature. Postoperative lethality can be caused by inadequacy of the intervention, when necrotized tissues are left in the wound and a large area of the lesion. 4. Scrotum restoration surgery can be performed later, but spontaneous closure of the tissue defect is also possible.

references

correspondence