World Journal of Surgery

, Volume 30, Issue 9, pp 1750–1754 | Cite as

Fournier’s Gangrene: Risk Factors and Strategies for Management

  • Hakan Yanar
  • Korhan Taviloglu
  • Cemalettin Ertekin
  • Recep Guloglu
  • Unal Zorba
  • Neslihan Cabioglu
  • Irfan Baspinar
Article

Abstract

Objective

The prognosis of Fournier’s gangrene (FG) depends on early diagnosis and management. In this study, our objective was to identify the distinct features of FG that may influence the clinical outcome.

Methods

A retrospective chart review was performed in patients with a diagnosis of FG between January 1999 and December 2003. Etiological and predisposing factors, causative microbiological organisms, and clinical outcome were investigated.

Results

Twenty-five men (71%) and 10 women (29%) were included in the study. Mean age was 59.7 ± 10.7 (range: 43–88) years. As a predisposing factor, diabetes mellitus (DM) was found to be in 46% of patients. All patients were treated by immediate debridement and wide-spectrum antibiotics. More than one bacterium was found in 75% of the patients’ tissue cultures, and most frequently E. coli (43%) was identified. Although there were no etiological factors in 25 patients (71%), various etiological factors were found in 10 patients (29%). Multiple debridements were performed in the majority of the cases. The overall mortality rate was 40%. The mortality rates were found to be relatively higher in patients with diabetes mellitus (DM; 50%), with delayed admission to the hospital (45%), and in patients presenting with sepsis at the first admission to the hospital (78%) compared with others. In the logistic regression model, the presence of sepsis was as the only significant independent risk factor for mortality in FG.

Conclusions

Despite the use of contemporary effective antibiotic treatment, aggressive debridements, and state-of-the-art intensive care conditions, FG still has high mortality and morbidity rates. In our series mortality rates were found to be higher in patients with delayed admission to the hospital, those with DM, and those who initially presented with sepsis.

References

  1. 1.
    Efem SE. The features and aetiology of Fournier’s gangrene. Postgrad Med J 1994;70:568–571PubMedCrossRefGoogle Scholar
  2. 2.
    Burge TS, Watson JP. Necrotizing fasciitis. Br Med J 1994;308:1453–1454Google Scholar
  3. 3.
    Laucks SS. Fournier’s gangrene. Surg Clin North Am 1994;74:1339–1352PubMedGoogle Scholar
  4. 4.
    Taviloglu K, Gunay K, Ertekin C, et al. Necrotizing fasciitis: therapeutical modalities. Turk J Surg 1996;12:128–133Google Scholar
  5. 5.
    Bugra D, Bozfakioglu Y, Buyukuncu Y, et al. Gangrene de Fournier. Etude analytique de six cas. J Chir 1990;127:115–116Google Scholar
  6. 6.
    Chawla SN, Gallop C, Mydlo JH. Fournier’s gangrene: an analysis of repeated surgical debridement. Eur Urol 2003;43:572–675PubMedCrossRefGoogle Scholar
  7. 7.
    Faucher LD, Morris SE, Edelman LS, et al. Burn center management of necrotizing soft-tissue surgical infection in unburned patients. Am J Surg 2001;182:563–569PubMedCrossRefGoogle Scholar
  8. 8.
    Nisbet AA, Thompson IM. Impact of diabetes mellitus on the presentation and outcomes of Fournier’s gangrene. Adult Urol 2002;60:775–779Google Scholar
  9. 9.
    Korkut M, Icoz G, Dayangac M, et al. Outcome analysis in patients with Fournier’s gangrene: report of 45 cases. Dis Colon Rectum 2003;46:649–652PubMedCrossRefGoogle Scholar
  10. 10.
    Villanueva-Saenz E, Martinez Hernandez-Magro P, Valdes Ovalle M, et al. Experience in management of Fournier’s gangrene. Tech Coloproctol 2002;6:5–10; discussion 11–13PubMedCrossRefGoogle Scholar
  11. 11.
    Gurdal M, Yucebas E, Tekin A, et al. Predisposing factors and treatment outcome in Fournier’s gangrene. Analysis of 28 cases. Urol Int 2003;70:286–290PubMedCrossRefGoogle Scholar
  12. 12.
    Corman JM, Moody JA, Aronson WJ. Fournier’s gangrene in a modern surgical setting: improved survival with aggressive management. BJU Int 1999;84:85–88PubMedCrossRefGoogle Scholar
  13. 13.
    Sherman J, Solliday M, Paraiso E, et al. Early CT findings of Fournier’s gangrene in a healthy male. Clin Imaging 1998;22:425–427PubMedCrossRefGoogle Scholar
  14. 14.
    Okizuka H, Sugimura K, Yoshizako T. Fournier’s gangrene: diagnosis based on MR findings. Am J Roentgenol 1998;158:1173–1174Google Scholar
  15. 15.
    Fillo J, Cervenakov I, Labas P, et al. Fournier’s gangrene: can aggressive treatment save life? Int Urol Nephrol 2001;33:533–536PubMedCrossRefGoogle Scholar
  16. 16.
    Korhonen K, Hirn M, Niinikoski J. Hyperbaric oxygen in the treatment of Fournier’s gangrene. Eur J Surg 1998;164:251–255PubMedCrossRefGoogle Scholar
  17. 17.
    DeCastro BJ, Morey AF. Fibrin sealant for the reconstruction of fournier’s gangrene sequelae. J Urol 2002;167:1774–1776PubMedCrossRefGoogle Scholar
  18. 18.
    Majeski JA, Alexander JW. Early diagnosis, nutritional support, and immediate extensive debridement improve survival in necrotizing fasciitis. Am J Surg 1983;145:784–787PubMedCrossRefGoogle Scholar
  19. 19.
    Voros D, Pissiotis C, Georgantas D, et al. Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection. Br J Surg 1993; 80:1190–1191PubMedGoogle Scholar
  20. 20.
    McHenry CR, Piotrowski JJ, Petrinic D, et al. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995;221:558–565PubMedGoogle Scholar
  21. 21.
    Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections: risk factors for mortality and strategies for management. Ann Surg 1996;224:672–683PubMedCrossRefGoogle Scholar
  22. 22.
    Taviloglu K, Cabioglu N, Cagatay A, et al. Idiopathic necrotizing fasciitis: risk factors and strategies for management. Am Surg 2005;71:316–320Google Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Hakan Yanar
    • 1
  • Korhan Taviloglu
    • 1
  • Cemalettin Ertekin
    • 1
  • Recep Guloglu
    • 1
  • Unal Zorba
    • 2
  • Neslihan Cabioglu
    • 3
  • Irfan Baspinar
    • 1
  1. 1.Department of General SurgeryIstanbul Medical Faculty, Istanbul UniversityIstanbulTurkey
  2. 2.Department of UrologyIstanbul Medical Faculty, Istanbul UniversityIstanbulTurkey
  3. 3.Department of General SurgeryHaseki Research HospitalIstanbulTurkey

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