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28 January 2018 : Clinical Research  

Fournier’s Gangrene: Clinical Presentation of 13 Cases

Bolesław Kuzaka1ABCDEF, Marta M. Wróblewska23ADEF*, Tomasz Borkowski1ABDE, Dariusz Kawecki4ABDE, Piotr Kuzaka5ABD, Grażyna Młynarczyk4D, Piotr Radziszewski1ABDEF

DOI: 10.12659/MSM.905836

Med Sci Monit 2018; 24: CLR548-555

Abstract

BACKGROUND: Fournier’s gangrene (FG) is a fulminant form of infective, polymicrobial, necrotizing fasciitis of the perineal, genital, and perianal regions. It commonly affects men, but women and children may also develop this type of tissue necrosis.

MATERIAL AND METHODS: This study is a retrospective analysis of the management of 13 cases of Fournier’s gangrene, diagnosed from among about 45 000 patients (men, women, and children) treated in the Department of General, Oncological, and Functional Urology (Medical University of Warsaw) from 1995 to 2013. All patients with Fournier’s gangrene underwent adequate surgical debridement of the necrotic tissues. Additional procedures (suprapubic cystostomy and orchiectomy) were necessary in 10 out of 13 (77.0%) patients. Seven out of 13 (53.8%) patients required subsequent reconstructive surgery of the scrotum.

RESULTS: All 13 patients were males, with a median age of 59.6 years (range: 42–68 years). The average hospital stay was 31.9 days (range: 16–46 days). None of our patients died due to Fournier’s gangrene. Bacteriological cultures of samples from the wounds showed polymicrobial flora, including the following genera of aerobes and anaerobes: Escherichia, Proteus, Klebsiella, Moraxella, Gemella, Enterococcus, Streptococcus, Staphylococcus, Bacteroides, Pseudoflavonifractor, Parabacteroides, Porphyromonas, Prevotella, Peptoniphilus, Peptostreptococcus, Actinomyces, Collinsella, and Lactobacillus.

CONCLUSIONS: Favorable outcome of FG treatment with low morbidity and no mortality can be achieved with rapid diagnosis, urgent surgical debridement of all necrotic tissues, and broad-spectrum empirical antimicrobial therapy, usually with combined antibiotics, against aerobic and anaerobic bacteria. Prevention of uroseptic shock by treating localized infection is compulsory.

Keywords: Debridement, Fasciitis, Necrotizing, Fournier’s Gangrene, Sepsis

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750