[Diagnosis and Treatment of Severe Fournier's Gangrene: Introduction of a Surgical Approach, Evaluation of Risk Factors, Microbiological Characteristics and Review of the Literature].

Abstract

BACKGROUND:

Fournier's gangrene is a necrotising fasciitis type I occurring in the perineal and genital region. The disease expands progressively and still has poor outcome, especially in critical ill patients. This study's focus was placed on the evaluation of risk factors and comorbidities, on the bacteriological spectrum, laboratory analyses, mortality and the course according to the algorithmic approach.

METHOD:

The medical records were reviewed of 10 patients with severe Fournier's gangrene from 2010 to 2019 who underwent intensive care therapy for at least 48 hours. Ten patients with Fournier's gangrene and sepsis and intensive therapy lasting at least 48 hours were recorded and analysed descriptively.

RESULTS:

The patient cohort consisted of six men and four women with a median age of 62 years (range 42 - 78 years). The median time between the onset of symptoms and hospitalisation was four days (range 3 - 5 days). The commonest aetiological event was a minor trauma. Predisposing factors included diabetes mellitus (30%) and overweight (80% BMI > 25). 90% of patients exhibited polymicrobial infection. All patients had systemic sepsis with SOFA-Score between 3 and 17 points. The mortality rate was 40%. Significant differences between surviving and deceased patients were shown by PCT, INR and aPTT (p < 0.05).

CONCLUSION:

Severe Fournier's gangrene continues to be a major challenge with a high mortality rate. Only rapid diagnosis, urgent extensive surgical debridement and intensive care therapy can lead to a favourable outcome in these critically ill patients. Vacuum-assisted closure can be successfully used in the management of soft-tissue defects.

• Authors: Aliona Wöhler, Robert Schwab, Christoph Güsgen, Sebastian Schaaf, Carolin Weitzel, Christoph Jänig, Arnulf Willms
• Journal: Zentralblatt fur Chirurgie (Zentralbl Chir) Vol. 147 Issue 5 Pg. 480-491 (Oct 2022) ISSN: 1438-9592 [Electronic] Germany
• Vernacular Title: Diagnose und zielgerichtete Therapie der Fournier-Gangrän mit septischem Verlauf: Vorstellung eines Behandlungsalgorithmus, Identifikation von Risikofaktoren, Betrachtung des Mikrobioms und Abgleich mit der Literatur.
• PMID: 33556981 (Publication Type: Journal Article, Review)
• Copyright: Thieme. All rights reserved.

Topics

• Adult
• Aged
• Debridement
• Female
• Fournier Gangrene (diagnosis, surgery)
• Humans
• Male
• Middle Aged
• Negative-Pressure Wound Therapy
• Risk Factors
• Sepsis