Outcome management of Fournier’s gangrene cases at tertiary hospital: 7 Years experience

2021 ◽  
pp. 039156032110464
Author(s):  
Soetojo Wirjopranoto ◽  
Yufi Aulia Azmi
Keyword(s):  
General Hospital ◽  
Severity Index ◽  
The Elderly ◽  
Tertiary Hospital ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Management Culture ◽  
Outcome Management ◽  
History Of ◽  
Analytic Design

Objective: This study aims to describe the condition of Fournier’s gangrene in Dr. Soetomo General Hospital from January 2014 to December 2020. Material and methods: This study used a retrospective analytic design, by taking data through medical records at Dr. Soetomo General Hospital from January 2014 to December 2020. This study used total sampling with recorded data: age, gender, length of stay, outcome, location, comorbidities, causes, management, culture results, and Fournier’s gangrene severity index (FGSI) score. Result: Of the 135 subjects collected, it was found that 55.56% were individuals over 50 years of age. About 91.11% were male patients, with some sites being in the scrotum 50.37%. Only 25.19% of patients had no comorbids, while the rest had a history of CKD, hypertension, diabetes, or a combination of these diseases. Bacterial cultures obtained were mostly caused by the Enterobacteriaceae bacteria group (32.59%). Of the subjects we studied who experienced mortality, it was found that all were from the group with FGSI >9. Conclusion: From the results of our descriptive study, at a glance, it appears that there is a tendency for the incidence of Fournier’s gangrene in the elderly and individuals with comorbidities. And the mortality rate increases with a high FGSI value. So that FGSI could be used as a predictor of mortality in patients with FG.

scholarly journals Management of peno-scrotal wound defects in a tertiary hospital in North-Western Nigeria: a 20-year retrospective review

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Abubakar Sadiq Muhammad ◽  
Ngwobia Peter Agwu ◽  
Abdullahi Abduwahab-Ahmed ◽  
Ahmed Mohammed Umar ◽  
Muhammad Ujudud Musa ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Graft Loss ◽  
External Genitalia ◽  
Tertiary Hospital ◽  
Advancement Flap ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Direct Closure ◽  
Secondary Intention ◽  
North Western

Abstract Background Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. The management of these patients includes initial resuscitation and subsequent wound care with or without wound cover. The aim of this study is to document our experience in the management of peno-scrotal defects in a tertiary hospital of North-Western Nigeria. Methods This is a 20-year retrospective study of patients managed for peno-scrotal wound defects by the Urology Unit in the Department of Surgery of our hospital from January 2001 to December 2019. Data were collected from the patients’ case notes and entered into a proforma. Data were analysed using SPSS version 25.0. Results A total number of 54 patients with peno-scrotal wound defects were managed within the study period with the mean age of 46.27 ± 22.09 years and a range of six weeks to 107 years. The wound defects were sequelae of Fournier’s gangrene in 42 patients (77.8%) and traumatic in 12 patients (22.2%). Healing by secondary intention was achieved in 20 patients (37.0%). Direct closure was done in 17 patients (31.5%), skin graft in nine patients (16.7%), and advancement flap in eight patients (14.8%) depending on the location and size of the defects. Fourteen patients (26.0%) developed surgical site infection ± wound dehiscence and partial graft loss. The complication rate was higher in post-Fournier’s gangrene wound defects, but without statistical significance (p = 0.018). Conclusion Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. Smaller wound defects were healed by secondary intention, while larger defects required either direct closure or the use of advancement flap or skin grafting depending on the location and size of the wound. The study reported a higher post-repair complication in patients that had Fournier’s gangrene.

scholarly journals Fournier’s gangrene: a retrospective review of management outcomes and seasonal variations of clinical presentation

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Ikenna I. Nnabugwu ◽  
Okechukwu O. Onumaegbu ◽  
Louis T. Okolie
Keyword(s):  
Hospital Admission ◽  
Seasonal Variations ◽  
Medical Records ◽  
Vital Signs ◽  
Skin Grafting ◽  
Severity Index ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Management Interventions ◽  
Split Skin Grafting

Abstract Background To review retrospectively the outcomes of management of Fournier’s gangrene (FG) and to assess for possible seasonal variations in clinical presentations of FG to a referral hospital in a tropical African country. Methods The medical records of patients who presented with FG from February 2012 to December 2019 were reviewed. Of interest were age of patient, vital signs at presentation, site of gangrene, duration of hospital admission, and management interventions deployed. Analysis was with SPSS® version 21. Results Twenty-three of 28 medical records could be analyzed. Median Fournier’s Gangrene Severity Index (FGSI) was 5 (IQR:3–10), the median Uludag-FGSI (UFGSI) was 7 (IQR:4–14). In 82.6%, the scrotum was the site of onset; in 8.7%, the lesion had spread beyond the pelvis. Diabetes mellitus (30.4%), HIV infection (13.0%) and nephropathy (17.4%) were identified co-morbidities. There were 2.4 ± 1.0 debridement sessions and 1.5 ± 1.3 transfused units of blood per patient. In 60.9%, the wound edges were undermined and apposed; in 17.4%, split skin grafting or fascio-cutaneous flap cover was deployed. In 17.4%, satisfactory wound closure needed more than 1 theater session. Mean duration of hospital admission was 51.4 ± 19.4 days. No mortality was recorded. Majority (91.2%) presented in hot, dry months of October through March with peak in December. No case presented in the wet months of May through September. Conclusion Meager resources notwithstanding, FG management outcomes are generally satisfactory. Furthermore, FG is observed to present mostly in the hot, dry months of the year in the 8 years under review.

Factors affecting length of stay in Fournier’s gangrene: a retrospective analysis of 10 years’ data

2020 ◽  
Author(s):  
Mithat Eksi ◽  
Yusuf Arikan ◽  
Abdulmuttalip Simsek ◽  
Osman Ozdemir ◽  
Serdar Karadag ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Severity Index ◽  
Mortality Rates ◽  
Fournier’S Gangrene ◽  
Index Score ◽  
Fournier's Gangrene ◽  
Wound Therapy ◽  
Severity Index Score

Abstract Background We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier’s gangrene. Material and Methods A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier’s gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier’s Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated. Results Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ± 2.5 days. As a result of the statistical analyses, it was found that Fournier’s Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier’s Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality. Conclusion Fournier’s gangrene is a mortal disease and an emergency condition. With the improvements in Fournier’s gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice.

scholarly journals The evaluation of microbiology and Fournier's gangrene severity index in 27 patients

2009 ◽  
Vol 13 (6) ◽  
pp. e424-e430 ◽  
Author(s):  
Mehmet Uluğ ◽  
Ercan Gedik ◽  
Sadullah Girgin ◽  
Mustafa K. Çelen ◽  
Celal Ayaz
Keyword(s):  
Severity Index ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene

scholarly journals Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases

2015 ◽  
Vol 9 (11-12) ◽  
pp. 800 ◽  
Author(s):  
Mohamed Tarchouli ◽  
Ahmed Bounaim ◽  
Mohamed Essarghini ◽  
Moulay Brahim Ratbi ◽  
Mohamed Said Belhamidi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Mortality Rate ◽  
Patient Survival ◽  
Length Of Hospital Stay ◽  
Severity Index ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Predisposing Factor ◽  
Duration Of Symptoms ◽  
Factors Affecting

Introduction: Fournier’s gangrene is a rapidly progressing necrotizing fasciitis of the perineum and genital area associated with a high mortality rate. We presented our experience in managing this entity and identified prognostic factors affecting mortality.Methods: We carried out a retrospective study of 72 patients treated for Fournier’s gangrene at our institution between January 2005 and December 2014. Patients were divided into survivors and nonsurvivors and potential prognostic factors were analyzed.Results: Of the 72 patients, 64 were males (89%) and 8 females (11%), with a mean age of 51 years. The most common predisposing factor was diabetes mellitus (38%). The mortality rate was 17% (12 patients died). Statistically significant differences were not found in age, gender, and predisposing factors, except in heart disease (p = 0.038). Individual laboratory parameters significantly correlating with mortality included hemoglobin (p = 0.023), hematocrit (p = 0.019), serum urea (p = 0.009), creatinine (p = 0.042), and potassium (p = 0.026). Severe sepsis on admission and the extent of affected surface area also predicted higher mortality. Others factors, such as duration of symptoms before admission, number of surgical debridement, diverting colostomy and length of hospital stay, did not show significant differences. The median Fournier’s Gangrene Severity Index (FGSI) was significantly higher in non-survivors (p = 0.002).Conclusion: Fournier’s gangrene is a severe surgical emergency requiring early diagnosis and aggressive therapy. Identification of prognostic factors is essential to establish an optimal treatment and to improve outcome. The FGSI is a simple and valid method for predicting disease severity and patient survival.

scholarly journals Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier’s Gangrene

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Kenji Okumura ◽  
Tadao Kubota ◽  
Kazuhiro Nishida ◽  
Alan Kawarai Lefor ◽  
Ken Mizokami
Keyword(s):  
Soft Tissues ◽  
Fournier’S Gangrene ◽  
Colostomy Closure ◽  
Anal Stenosis ◽  
Fournier's Gangrene ◽  
Anal Stricture ◽  
Internal Hemorrhoids ◽  
Old Japanese ◽  
History Of ◽  
Diverting Colostomy

Background. Anal stenosis is a rare but serious complication of anorectal surgery. Severe anal stenosis is a challenging condition. Case Presentation. A 70-year-old Japanese man presented with a ten-hour history of continuous anal pain due to incarcerated hemorrhoids. He had a history of reducible internal hemorrhoids and was followed for 10 years. He had a fever and nonreducible internal hemorrhoids surrounding necrotic soft tissues. He was diagnosed as Fournier’s gangrene and treated with debridement and diverting colostomy. He needed temporary continuous renal replacement therapy and was discharged on postoperative day 39. After four months, severe anal stenosis was found on physical examination, and total colonoscopy showed a complete anal stricture. The patient was brought to the operating room and underwent colostomy closure and anoplasty. He recovered without any complications. Conclusion. We present a first patient with a complete anal stricture after diverting colostomy treated with anoplasty and stoma closure. This case reminds us of the assessment of distal bowel conduit and might suggest that anoplasty might be considered in the success of the colostomy closure.

scholarly journals 122: The Fournier’s Gangrene Severity Index for Predicting Outcome of the Disease: Is it Useful?

2004 ◽  
Vol 171 (4S) ◽  
pp. 32-32
Author(s):  
Eugene Lin ◽  
Stone Yang ◽  
Hsi-Hsien Hsu ◽  
Yung-Chiong Chow
Keyword(s):  
Severity Index ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Predicting Outcome

scholarly journals Emergency management and it’s effect on clinical profile of Fournier’s gangrene in patients presenting at a rural setup

2019 ◽  
Vol 6 (12) ◽  
pp. 4397
Author(s):  
Tausif Kamal Syed ◽  
Dilip K. Apturkar ◽  
K. N. Dandekar
Keyword(s):  
Serum Creatinine ◽  
Emergency Management ◽  
Leucocyte Count ◽  
External Genitalia ◽  
Severity Index ◽  
Fournier’S Gangrene ◽  
Total Leucocyte Count ◽  
P Value ◽  
Fournier's Gangrene ◽  
Soft Tissue Necrosis

Background: Fournier’s gangrene (FG) is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. This study describes our experiences in the management of FG and identifies prognostic factors.Methods: It is a descriptive prospective study in 71 patients with FG treated at Pravara Rural Medical College and Hospital, Loni, who presented between September 2013 and September 2015.Results: In the present series of 71 patients, 57% were between 50-70 yrs. UTI and alcohol consumption being most common co-morbid conditions and scrotal abscess (53.52%) being the most common presentation. Serum creatinine (p value 0.0008), total leucocyte count at presentation (p value 0.004) had a significant association with duration of recovery. The mean duration of stay was 16.08±3.28 days with a median of 15 days. The Fournier gangrene severity index score calculated was <9 in 59.15% of patients, and >9 in the remaining ≈40% with a mean of 8.309±3.49. A single mortality was recorded during our study.Conclusions: Serum creatinine and total leucocyte count at presentation could play a pivotal role in not only initial emergency management but also as factors for monitoring the progress of treatment.

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