Fournier Gangrene: Case Report & Litarature Review

Introduction: Necrotizing fasciitis of the perineal and vaginal region is a symptom of Fournier's gangrene, which is caused by a synergistic polymicrobic infection. The clinical presentation varies depending on the original aetiology, ranging from anorectal or vaginal pain with limited evidence of cutaneous necrosis to a rapidly spreading necrosis of the skin and soft tissue, to systemic sepsis without any obvious signs or symptoms. Case history: A 65-year-old male who was admitted in hospital with the chief complaint of Scrotal enlargement, discomfort, hyperemia, pruritus, crepitus, and fever. There may also be a foul-smelling discharge. Symptoms usually appear during a two- to seven-day period. Soft-tissue gas may be present before clinical crepitus is detected. The patient with Fournier gangrene frequently seems poorly on physical examination, with prodromal signs of fever and lethargy lasting 2-7 days. Edema of the overlaying skin is usually present, as is acute pain and tenderness in the genitalia; pruritus may also be present.Skin may show evidence of trauma, surgery, insect or human bites or injection sites, In Respiratory system, B/L Air entry present. In cardiovascular system, S1 and S2 sound heard and Patient get conscious and well oriented to time, place, and person. Then, as quickly as possible, treatment was began; he did not improve after treatment, and treatment would continue till the conclusion of my care. Conclusion: We focus on professional management and superior nursing care in this study so that we may provide the complete treatment that Fournier Gangrene requires while also effectively managing the complex case. After a full recovery, the patient's comprehensive health care team collaborates to help the patient regain his or her previous level of independence and happiness.

Diagnosis and Treatment of Fournier Gangrene in Secondary Hospital; A Report of Two Cases

Fournier Gangrene (FG) is a specific form of necrotizing fasciitis that localized on genital and perianal, although it is rare but it is progressively fast and potentially fatal. The incidence of FG is 1.6 cases per 100,000 males, with a case fatality rate of 7.5%. Proper diagnosis and management are very important to avoid serious complications. Early debridement, broad-spectrum antibiotics and immediate supportive therapy, can reduce mortality. The objective is reporting two cases of FG who were admitted to a secondary hospital and what is the best management based on our setting. The method is qualitative observational study. The material collected through direct interview and from medical record. The best management for our setting was rapid diagnosis and followed by prompt debridement.

Effect of Colostomy on Treatment Outcome in Fournier Gangrene: A Prospective Comparative Study

Background and Aim: Value of colostomy in management of Fournier gangrene (FG) is a debatable issue. Almost all relevant studies are retrospective and included heterogeneous patients’ groups. The present prospective study aimed to evaluate the role of colostomy in management of FG affecting the perianal region in 2 well-matched FG groups. Patients and Methods: The present prospective comparative study included 30 patients with FG associated with extensive involvement of the perianal region. They comprised 15 patients subjected to colostomy and other 15 patients who refused to perform the procedure. Colostomy was performed after the first debridement. Outcome parameters in the present study included time to wound healing, length of hospital stay, and inhospital mortality. Results: Comparison between the studied groups regarding the preoperative characteristics revealed no statistically significant differences. Postoperatively, patients in the colostomy group had significantly fewer number of debridements (1.3 ± 0.5 vs 2.7 ± 1.2, P < .001), shorter hospital stay (9.5 ± 3.3 vs 29.9 ± 6.2 days, P < .001), and significantly shorter time to wound healing (16.5 ± 3.9 vs 42.9 ± 6.9 days, P < .001). Also, patients in the colostomy group had significantly lower rate of wound dehiscence, wound infection, and flap ischemia. However, the difference wasn’t statistically significant. Conclusions: Aggressive treatment of FG aided by colostomy after first debridement would result in better clinical outcome.

Fournier gangrene, use of negative pressure wound therapy

Resumen Los sistemas de terapia con presión negativa (TPN) han demostrado su eficacia en el manejo del cierre temporal del abdomen en casos de trauma grave, síndrome compartimental y sepsis. En la práctica clínica también se aplica su uso en el proceso de curación de heridas con gran carga infecciosa para acelerar su curación disminuyendo el débito del exudado. La gangrena perineal se define como una fulminante y progresiva infección de la región perineal, y/o genital. Su importancia radica en la elevada mortalidad que alcanza entre un 3 a 67%. Exponemos un caso de uso de la TPN en un paciente con una gangrena de Fournier. Varón 65 años, hipertenso, diabético. Consulta por dolor anal y fiebre. A la exploración defecto a las 11h en posición de litotomía con drenaje espontáneo de absceso, importante celulitis y empastamiento. Se explora bajo anestesia encontrando celulitis perianal con necrosis extendida por ambas fosas isquiorectales, se realiza necrosectomía de toda la circunferencia anal (Figura 1). Tras varias curas, se confecciona colostomía temporal dada la severa afectación esfinteriana y la colocación de sistema de TPN (Figura 2). Se realizan varias curas con TPN acelerando la resolución de la infección. Tras 44 días de ingreso, el paciente es dado de alta pendiente de reconstrucción del tránsito.

Fournier Gangrene Severity Index and Diabetes Mellitus: A Significance Correlation among Fournier Gangrene Patients in Single Center Hospital

BACKGROUND: Fournier gangrene (FG) is an urological emergency in the form of progressive necrotizing fascitis caused by polymicrobial infection which affects the perineum and external genitalia. FG that is not diagnosed and treated properly will result in severe morbidity and even mortality for the patient. The assessment of FG becomes clearer with the creation of a scoring system that predicts patient prognostic and therapeutic outcomes, known as the Fournier ganggreen severity index (FGSI). This FGSI includes clinical and laboratory examinations, namely, temperature, pulse, respiratory rate, levels of sodium, potassium, leukocytes, hematocrit, and blood serum bicarbonate. AIM: We aimed to present descriptive retrospective study, which examined the relationship between age and DM with FGSI in FG patients at the Regional General Hospital. METHODS: Data were taken from January 2017 to December 2020 at the Urology Department, dr. Moewardi Hospital Surakarta. There were 32 cases of FG patients, consisting of 20 patients with diabetes mellitus (DM) and 12 non-DM patients. RESULTS: This study found that FG patients with an FGSI score <9 were 24 patients (75%), FG patients with an FGSI score of >9 were 8 patients (25%). Judging by the distribution of the FGSI score according to the age of the FG patient using the chi-square technique, the value p = 0.045. The p-value <0.05 means that at the 5% significance level the difference in the proportion of FGSI scores between age categories of FG patients is significant. The distribution of the FGSI score according to the DM comorbid showed that there were nine patients with an FGSI score of >9 (45.5%) with comorbid DM and no patients without the DM comorbid. Result of statistical test using the Chi-square technique was p = 0.036. The p-value < 0.05 means that at the 5% significance level the difference in the proportion of FGSI scores between patients with and without comorbid DM is significant. CONCLUSION: Judging by the distribution of the FGSI score, it can be concluded that there is significant relationship between the age of the FG patient and the FGSI score and there is a significant relationship between the DM comorbid and the FGSI score in FG patients at dr. Moewardi Hospital Surakarta in the period January 2017 to December 2020.

OUR EXPERIENCE IN DIAGNOSIS AND TREATMENT OF NECROTIZING FASCIITIS

Background: Necrotizing fasciitis (NF) is a severe, relatively rare and potentially deadly infection, which is usually caused by one or two pathogenic microorganisms. The target areas that are affected are the skin and the subcutaneous tissues of the lower and the upper limbs, the scrotum, the perineal region (Fournier gangrene) and the abdominal wall. The early diagnosis and aggressive surgical treatment are of great importance for the outcome of this potentially lethal disease. Methods: Eleven patients with diagnosis of NF had been treated in the Clinic of Plastic and Reconstructive surgery of St. George Hospital, Plovdiv for a five-year period (2013-2018). Based on the demographic, clinical and laboratory data the presurgical, the following surgical treatment, and the postsurgical management were analyzed. Results: The mean age of the patients was 58.7 years (median: 56 years, range 37–87 years) and 75% were men. Old age (above 65 years) and female gender correlated significantly with lethality. Most often the regions affected were the perineum and the scrotum (46.8%), followed by lower limbs (35.5%), upper limbs and abdominal wall (8.1%). Diabetes mellitus, oncologic diseases, alcohol addiction and chronic hepatic and renal diseases were found to be predisposing factors for development of NF. We started treatment with broad spectrum antibiotics, early and vigorous drainage and meticulous debridement with wide excision of the damaged tissues. Vacuum therapy was applied as part of the treatment of the defects. It allowed continuous wound cleaning and accelerated formation of granulation tissue, followed by definite closure of the defect. Conclusion: The diagnosis of NF needs adequate proceedings and treatment of the cases among surgeons as its clinical presentation is unspecific. The prompt surgical debridement and excision is the mainstay in the treatment of all patients and repeated surgical excisions are required. Plastic surgery is an undeniable stage in the complex treatment of NF regarding the large size of the wound and necessity of definite closure of the soft tissue defects.