Management of Fournier's Gangrene: An Eleven Year Retrospective Analysis of Early Recognition, Diagnosis, and Treatment

Norton, Kathryn S.; Johnson, Lester W.; Perry, Travis; Perry, Katina H.; Sehon, James K.; Zibari, Gazi B.
August 2002
American Surgeon;Aug2002, Vol. 68 Issue 8, p709
Academic Journal
Fournier's gangrene is an infectious necrotizing fasciitis of the perineum and genital regions. It is a synergistic infection caused by a mixture of aerobic and anaerobic organisms. The mortality rate from this infection ranges from 0 to 67 per cent. One of the most important determinants of overall outcome is early recognition and extensive surgical debridement upon initial diagnosis. This is followed by aggressive antibiotic therapy combined with other precautionary and resuscitative measures. Our hypothesis is that early aggressive surgical debridement combined with broad-spectrum antibiotic coverage results in decreased mortality from Fournier gangrene. The objective of this study was to determine our morbidity and mortality as compared with other institutions. This was a retrospective review of 200 charts of patients from 1990 through 2001. The charts reviewed included patients with a diagnosis of male and female genital abscesses, cellulitis, necrotizing fasciitis, and vascular disorders. This resulted in 33 patients who had a final diagnosis of Fournier's gangrene. There were 26 (79%) males and seven (21%) females with a diagnosis of Fournier's gangrene. The patients ranged in age from 30 to 85 years (mean age 51.5). There were a number of predisposing factors that were examined. Thirteen patients (39%) were diabetic, 18 (55%) suffered from hypertension, 18 (55%) were obese, and 18 (55%) were cigarette smokers. Four patients (12%) had no predisposing factors. The treatment consisted of wide surgical debridement which was performed in all 33 patients. Most patients received multiple debridements ranging from one surgery to seven (mean 3.25) per hospital stay. The majority of patients received broad-spectrum antibiotic coverage. Three patients died, which resulted in a mortality rate of 9 per cent. Early recognition and aggressive surgical debridement is the most essential intervention in stopping the rapidly progressing infectious process of Fournier's...


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