scholarly journals A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nan Zhang ◽  
Xin Yu ◽  
Kai Zhang ◽  
Tongjun Liu
Keyword(s):  
Necrotizing Fasciitis ◽  
Case Series ◽  
Fournier’S Gangrene ◽  
Wound Management ◽  
Risk Indicator ◽  
Fournier's Gangrene ◽  
Retrospective Case ◽  
Female Ratio ◽  
Male Predominance ◽  
Lrinec Score

Abstract Background To describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement. Methods We retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented. Results There were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits. Conclusions Fournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

scholarly journals A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region

2020 ◽  
Author(s):  
Nan Zhang ◽  
Xin Yu ◽  
Kai Zhang ◽  
Tongjun Liu
Keyword(s):  
Necrotizing Fasciitis ◽  
Case Series ◽  
Fournier’S Gangrene ◽  
Wound Management ◽  
Risk Indicator ◽  
Fournier's Gangrene ◽  
Retrospective Case ◽  
Female Ratio ◽  
Male Predominance ◽  
Lrinec Score

Abstract Background To describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement. Methods We retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented.Results There were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits.Conclusions Fournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

scholarly journals A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region

2020 ◽  
Author(s):  
Nan Zhang ◽  
Xin Yu ◽  
Kai Zhang ◽  
Tongjun Liu
Keyword(s):  
Necrotizing Fasciitis ◽  
Case Series ◽  
Fournier’S Gangrene ◽  
Wound Management ◽  
Risk Indicator ◽  
Fournier's Gangrene ◽  
Retrospective Case ◽  
Female Ratio ◽  
Male Predominance ◽  
Lrinec Score

Abstract BackgroundTo describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement.MethodsWe retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented.ResultsThere were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits.ConclusionsFournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

scholarly journals A retrospective case series of Fournier’s gangrene: necrotic fasciitis in perineum and crissum

2020 ◽  
Author(s):  
Nan Zhang ◽  
Xin Yu ◽  
Kai Zhang ◽  
Tongjun Liu
Keyword(s):  
Case Series ◽  
Advancement Flap ◽  
Fournier’S Gangrene ◽  
Wound Management ◽  
Fournier's Gangrene ◽  
Retrospective Case ◽  
Female Ratio ◽  
Male Predominance ◽  
Lrinec Score ◽  
Secondary Healing

Abstract BackgroundTo describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement.MethodsWe retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented.ResultsThere were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of LRINEC score of 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. NPWT was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits.ConclusionsFournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

Dangers of delayed diagnosis of perianal abscess and undrained perianal sepsis in Fournier’s gangrene: a case series

2020 ◽  
Vol 13 (10) ◽  
pp. e236503
Author(s):  
Edgardo Solis ◽  
Yi Liang ◽  
Grahame Ctercteko ◽  
James Wei Tatt Toh
Keyword(s):  
Delayed Diagnosis ◽  
Case Series ◽  
Perianal Abscess ◽  
Scoring Systems ◽  
Fournier’S Gangrene ◽  
Necrotising Fasciitis ◽  
Risk Indicator ◽  
Fournier's Gangrene ◽  
Perianal Sepsis

Fournier’s gangrene (FG) is a rapidly progressing infective necrotising fasciitis of the perianal, perineal and genital region. It is characterised by its aggressive nature and high mortality rates of between 15% and 50%. While it has been commonly found to primarily develop from urological sources, there have been increasing reports of the role of colorectal sources as the underlying aetiology of FG. Presented is a case series of four FG presentations at a single institution during a 12-month period as a result of underlying untreated perianal disease highlighting its dangers in progressing to a deadly infection, advocating for early and aggressive surgical debridement, and the role of adjunct scoring systems, such as Laboratory Risk Indicator for Necrotising Fasciitis, in guiding clinical diagnosis.

scholarly journals Fournier’s Gangrene: Current Practices

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
M. N. Mallikarjuna ◽  
Abhishek Vijayakumar ◽  
Vijayraj S. Patil ◽  
B. S. Shivswamy
Keyword(s):  
Necrotizing Fasciitis ◽  
External Genitalia ◽  
Severity Index ◽  
Fournier’S Gangrene ◽  
Risk Category ◽  
Urethral Reconstruction ◽  
Risk Indicator ◽  
Fournier's Gangrene ◽  
Fournier Gangrene ◽  
Severity Index Score

Fournier’s gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20–30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes.

scholarly journals Orbital solitary fibrous tumors: a multi-centered histopathological and immunohistochemical analysis with radiological description

2020 ◽  
Vol 40 (3) ◽  
pp. 227-233
Author(s):  
Hind Manaa Alkatan ◽  
Abrar K. Alsalamah ◽  
Abdulrahman Almizel ◽  
Khalid M. Alshomar ◽  
Azza MY Maktabi ◽  
...  
Keyword(s):  
Sample Size ◽  
Case Series ◽  
Adult Patients ◽  
Histopathological Analysis ◽  
Retrospective Case ◽  
Female Ratio ◽  
Male Predominance ◽  
Tissue Diagnosis ◽  
Solitary Fibrous Tumors ◽  
Rare Tumors

ABSTRACT BACKGROUND: Solitary fibrous tumors (SFT), formerly called hemangiopericytoma, are rare tumors derived from mesenchymal cells originally described in the pleura, but these tumors may affect extraserosal tissues including the lacrimal gland and orbit. OBJECTIVE: Conduct a multi-centered clinical, radiological and histopathological analysis of 17 orbital SFT cases. DESIGN: A retrospective case series. SETTING: Three eye centers in two countries. PATIENTS AND METHODS: The data collected from the charts of 17 adult patients presenting with tissue diagnosis of orbital hemangiopericytoma or SFT from January 2003 to December 2018 included demographics, clinical imaging and histopathological information including immunohistochemical (IHC) characteristics. MAIN OUTCOME MEASURES: The demographic characteristics, clinical presentation, and histopathological patterns or variants of SFT were analyzed. SAMPLE SIZE: 17 adult patients. RESULTS: Mean age was 45 years (range 23-80 years). Male to female ratio was 3:1. The right eye was affected in 12 (70.5%) patients. Commonest presentation was proptosis in 13/17 (76% of patients). Other symptoms were impaired motility (29%) and ptosis (11%). Lesions mostly affected the medial orbit (35%), then orbital apex in 11%. The histopathological classic pattern-less variant was the commonest. One case with aggressive behavior, multiple recurrences and atypical features was encountered. Immunohistochemical (IHC) markers used included CD34 expression in all cases, Bcl-2 expression in 10/11, CD99 in 9/9 and Vimentin in 4/4. STAT6 was used in 2 cases. CONCLUSIONS: SFTs are rare tumors affecting the orbit in both genders equally in their mid-forties, but showed male predominance in our analysis with a predominant classic histopathological pattern. Tissue diagnosis is essential and requires IHC studies for confirmation. LIMITATIONS: Sample size is relatively small owing to the rarity of this tumor in the orbit. CONFLICT OF INTEREST: None.

scholarly journals Necrotizing fasciitis: diagnostic and prognostic value of laboratory risk indicator for necrotizing fasciitis score

2019 ◽  
Vol 6 (5) ◽  
pp. 1750
Author(s):  
Angir Soitkar ◽  
Murtaza Akhtar ◽  
Abhay Choudhari ◽  
Satish Deshmukh
Keyword(s):  
Survival Analysis ◽  
Necrotizing Fasciitis ◽  
Prognostic Value ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Risk Indicator ◽  
Care Hospital ◽  
Female Ratio ◽  
Lrinec Score ◽  
Diagnostic And Prognostic Value

Background: Necrotizing fasciitis (NF) is a potentially life threatening disease. Delayed recognition and surgical intervention is directly linked to increased mortality. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score, a laboratory oriented tool has potential to prevent morbidity and mortality but there exhibits a controversy regarding its utility which needs re-evaluation to prove it’s utility.Methods: A tertiary care hospital based observational study aims to evaluate diagnostic and prognostic value of LRINEC score. Patient above 18 years clinically diagnosed as SSTI and confirmed as NF histopathologically without co-morbidities were enrolled as subjects. Clinical evaluation and laboratory oriented LRINEC score were the study factors. Outcome factors were morbidity and mortality and histopathological confirmation of NF. Patients were analyzed as cellulitis and NF with identification of factors associated with NF; Univariate analysis with Kaplan-Meier survival analysis and ROC plotting was done.Results: Total 166 patients were enrolled with mean age of 47.14±15.76 years and 2:1 is the male : female ratio and. A total of 117 patients were diagnosed as Cellulitis and 49 patients were NF. Clinically Discharge, fever and cuticular necrosis was statistically associated with NF (p<0.01). Mortality in NF was 22.4% and no mortality in Cellulitis. Mean LRINEC score in cellulitis and NF was 1.95±0.972 and 7.57±1.51 (p<0.01). Survival analysis graph and ROC showed LRINEC score of 6 as diagnostic and score ≥9 as poor prognostic indicator.Conclusions: LRINEC score is a useful diagnostic and prognostic tool in patients of NF.

Gangrena de Fournier. Reporte de caso

2020 ◽  
Vol 63 (5) ◽  
pp. 26-30
Author(s):  
Paloma Pérez Ladrón de Guevara ◽  
Georgina Cornelio Rodríguez ◽  
Oscar Quiroz Castro
Keyword(s):  
Mortality Rate ◽  
Necrotizing Fasciitis ◽  
Broad Spectrum ◽  
Soft Tissues ◽  
Fournier’S Gangrene ◽  
Type Ii ◽  
Necrotic Tissue ◽  
Fournier's Gangrene ◽  
Necrotizing Fascitis ◽  
Key Words Fournier's Gangrene

Fournier’s Gangrene is a type II necrotizing fascitis that leads to thrombosis of small subcutaneous vessels and spreads through the perianal and genital regions and the skin of the perineal. Most cases have a perianal or colorectal focus and in a smaller proportion it originates from the urogenital tract. The mortality rate varies between 7.8 and 50%1-3, only timely diagnosis decreases the morbidity and mortality of this condition. Treatment includes surgical debridement of all necrotic tissue and the use of broad-spectrum antibiotics. Key words: Fournier’s gangrene; gangrene; necrotizing fasciitis; infectious necrotizing of soft tissues.

scholarly journals Algorithm of rational approach to reconstruction in Fournier’s disease

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 1028-1037
Author(s):  
Domenico Tripodi ◽  
Maria Ida Amabile ◽  
Federica Gagliardi ◽  
Federico Frusone ◽  
Marzia Varanese ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Fournier’S Gangrene ◽  
Rational Approach ◽  
Skin Grafts ◽  
Local Infection ◽  
Fournier's Gangrene ◽  
Rare Form ◽  
Perineal Region ◽  
Reconstructive Technique ◽  
Diabetes And Obesity

Abstract Background Fournier’s gangrene is a rare form of necrotizing fasciitis that affects the genital area up to the perineal region and sometimes the abdominal wall. Objectives Our article aims to show that in the treatment of extensive forms of Fournier’s gangrene, correct use of flap and skin grafts and a quick reconstruction of the exposed tissues avoid scarring retraction of the testicles and deformation of the penis. Materials and methods We retrospectively reviewed the clinical and photographic data of Fournier’s gangrene cases treated at our Institute. The data were evaluated to obtain an estimate of the results of the reconstructive technique used, in terms of percentage of occurred healings and eventual complications. Results A total of 34 patients underwent surgery for Fournier’s gangrene. In nine cases (26.5%), we had minor complications: in four patients, suffering from diabetes and obesity, a retard in attachment of graft occurred, while in five patients with perianal problems there was a delay in healing due to the onset of local infection. Conclusion The reconstruction approach described here may reduce surgical times. In Fournier’s gangrene, the exposed tissues must be reconstructed as quickly as possible.

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