Fournier's gangrene: Our experience in 5 years, bibliographic review and assessment of the Fournier's gangrene severity index. Department of Urology. Hospital Universitario Dr. It is potentially fatal, and affects any age and gender. The severity index for Fournier's gangrene has been described; it is useful for evaluating the prognosis of these patients. Our goal is to report our experience with this disease over the past 5 years and evaluate the index in retrospect.

Author:Tejind Bazuru
Language:English (Spanish)
Published (Last):5 January 2006
PDF File Size:17.66 Mb
ePub File Size:8.40 Mb
Price:Free* [*Free Regsitration Required]

Fournier's gangrene: Our experience in 5 years, bibliographic review and assessment of the Fournier's gangrene severity index. Department of Urology. Hospital Universitario Dr. It is potentially fatal, and affects any age and gender. The severity index for Fournier's gangrene has been described; it is useful for evaluating the prognosis of these patients. Our goal is to report our experience with this disease over the past 5 years and evaluate the index in retrospect.

Methods: We analyzed medical records of patients with Fournier gangrene over the last 5 years at the University Hospital "Dr. The average severity index was 5.

Discussion: In our hospital, Fournier's gangrene is rare. Nevertheless, there is a rapid diagnosis protocol and therapeutic management is performed immediately. Until now, the immediate surgical treatment and early initiation of antibiotic therapy remains the best therapeutic option.

Conclusion: There is a relationship between the index of severity and patient survival, which may become a useful parameter in evaluating these patients. Key words: Fournier's gangrene. Severity Index. Necrotizing fasciitis. Genital gangrene. Palabras clave: Gangrena de Fournier. Fascitis necrotizante. Gangrena genital. This infectious and necrotic skin lesion, although it was initially described by Bau-rienne in 1,3 is named after Jean Alfred Fournier, French dermatologist who in described a syndrome of unexplained gangrene in the penis and scrotum in 5 young men with no other pathology basis of sudden onset and rapid progresion 2.

This condition is potentially fatal, affects any age and gender, has been reported even in neonates 4 , is characterized by rapid progression of infection in soft tissue caused by the synergistic action of several agencies that extend along fascial planes, subfacial causing necrosis of these tissues and destruction 5.

This necrosis is secondary to thrombosis of small vessels, which is due to endarteritis obliterans caused by the spread of microorganisms into the subcutaneous space platelet aggregation stimulated by heparinasa produced by aerobic and anaerobic 3 , that in addition to generating local edema, hypoxia, difficulty by local blood supply, which favors the development of anaerobic bacteria, these microorganisms produce hydrogen and nitrogen that accumulate in tissues causing crepitation 5. It is a situation that warrants urgent radical surgical treatment debridement , in addition to the use of antibiotics apropiados 7.

The time interval from onset of symptoms specific to the process until the request for medical care is from 2 to 7 days, on average. This time determines the extent of the necrotic area and a critical influence on the prognosis 1. Within the imaging studies of X-rays are useful in demonstrating the presence of gas in soft tissues, more useful is the ultrasound.

Has been described gangrene severity index of Fournier 5,8 Table I , which is useful for evaluating the prognosis of these patients. The management ranges from emergency surgery debridement , managing topic sodium hypochlorite, hydrogen superoxide and even honey , antibiotics, until hiperbaric oxygen 12, The purpose of this paper is to report our experience over the past 5 years regarding this disease and to assess retrospectively the rate of severity and to assess whether our results are comparable to those published.

We analyzed medical records of patients admitted with a diagnosis of Fournier's gangrene in a period from June to June , at the University Hospital "Dr. Joseph E. The criteria used to establish the diagnosis were the anamnesis and physical examination of patient records were incomplete and excluded those who did not meet inclusion criteria. All patients required early surgical debridement and administration of parenteral antibiotics for at least a double outline, this will change once the antibiograms obtained from samples sent to bacteriology.

We analyzed in retrospect the clinical records of these patients, assessing the age, gender, symptoms, physical examination, laboratory tests on admission, surgical procedures performed, transfusion, pathogen isolation, antibiotic administered and index of severity for this way to establish the criteria that could be very useful to evaluate these patients in the emergency department to predict what the prognosis for each.

We obtained a total of 63 cases of patients with Fournier's gangrene in this period of 5 years, of whom 13 were excluded for not fulfilling the inclusion criteria.

The most frequent pathogens were E. The antibiotics scheme most commonly used was Ofloxacin mg IV every 12hrs plus clindamycin mg IV every 6hrs, which was modified according to the antibiogram results.

And if it changed was added a third-generation cephalosporin. Fournier's gangrene is a necrotizing fasciitis of soft tissues of the scrotum and perineum of very rapid evolution can affect both men and women and usually patients have concomitant risk factors 2,14 Figure 4 and 5.

In its early Fournier's gangrene was described as an idiopathic entity, but in most cases a perianal infection, urinary tract and local trauma or skin condition at that level can be identified 9 , as noted in our review most of the patients had infection as the origin of the perianal area, scrotum, or urethra and others, there was none in which the origin could not be identified. The average age was It is important to emphasize these results because, as we see is a condition that is often present in patients of childbearing age in particular, decreasing at the extremes of life, for reasons that are not entirely clear but could be related with sexually active or simply with the activity of the patient.

Of the 6 patients who died, 3 were known diabetics one with figures of serum glucose to , 2 were not known diabetic and was diagnosed during their stay in the institution and not the one suffering.

Relationship was found between increased mortality and duration of symptoms before hospitalization, the percentage of area involved, and presence of serum BUN and creatinine hogh 15 , we found that patients who died were on average 7.

The most common sites are launched from the urethra trauma, urolithiasis, catheterization, fistulas, stenosis, massage or prostate biopsy , anorectal perianal abscesses, fissures, hemorrhoids, carcinoma, appendicitis, diverticulitis, and perforation by foreign body , skin infections insertion of penile prosthesis, cauterization of warts, skin abscesses and in women Bartholin abscess, vulvar, vulvar or perineal wounds, episiotomy, hysterectomy, septic abortion, etc No difference was found between the most common site of origin in our series compared with those reported in the literature, these being the scrotum, perianal and urethral like these more frequent and the perianal the worst prognosis This entity represents a polymicrobial infection in most cases, so that both aerobic and anaerobic organisms may be present, although not all bacteria involved can be identified in cultures Anaerobic bacteria are the least frequently isolated, and enterobacteria in turn are the most frequent and are usually found in particular E.

The aerobic bacteria causing platelet aggregation and an acceleration of coagulation by complement fixation, while certain anaerobes promote the formation of clots in a different way to produce a heparinasa.

These factors explain the characteristic obliterated endarteritis with vascular thrombosis observed in this necrotizing fasciitis which is responsible for the subcutaneous tissue necrosis and gangrene of the skin.

Bacteroides inhibit the phagocytosis of aerobic bacteria destruction. In this way, it is a destructive infection of the combination of relatively non-pathogenic organisms and the immune status of the patient. Cutaneous manifestations begin with edema, erythema and local hardening of the tissue surface areas later appear as echymosis and necrosis that often accompanied by crepitation and end of drainage purulent material 2.

Systemic manifestations are also quite varied and usually attack from the state, fever, to the presence of septic shock and usually these manifestations are related to the extent of necrosis. With regard to laboratory findings showed leukocytosis and the majority as mentioned in the review that we do in presenting septic shock thrombocytopenia can occur as a decrease in clotting factors.

The diagnosis was based on clinical findings. Conventional radiology can be helpful in assessing some cases revealing the presence of gas in soft tissues. This is not pathognomonic but must warn of the possibility of necrotising subcutaneous infection.

Ultrasound can be useful for distinguishing between Fournier's gangrene and other diseases that occur with scrotal pain, erythema and scrotal volume increase. CT and MRI can help us to delineate the extent of infection and location of outbreaks.

These studies are essential for a correct diagnosis and offer appropriate treatment. In our series, no methods were used for imaging studies due to diagnostic certainty provided by the clinic as well as the lateness of the table at the beginning. In our study, all patients received antimicrobial therapy of first instance with a double outline based Ofloxacin mg IV every 12hrs more Clindamycin mg IV every 6hrs, covering this way gramm negative, positive and anaerobic, this scheme was modified after it had the antibiogram and the culture of the abscess secretion, which never exceeded 7 days.

On admission all patients received surgical and medical management as soon as possible in this way trying to avoid increased morbidity and complications death of the patient, and analyzing this situation we find that there are several attempts to predict the prognosis of patients with Fournier's gangrene, Laora et al. It has been well documented usefulness of this index for predicting hospital stay and the number of debridement in patients who survived , which could not be demonstrated in our series.

Hospitalization for this disease is extremely long, refers to an average of 6 weeks 23 which is far above average that we found was Fournier's gangrene in our area is almost exclusively in males and frequently is associated with the presence of diabetes mellitus, even in some cases may be the initial manifestation of the disease.

There is a delay of almost a week between the onset of first symptoms and seeking medical care, which negatively affects the prognosis of the patient. The debridement is the main form of surgical treatment of the disease and requires further surgical intervention in most patients. The site of origin of the infection more common in our patients was the scrotum, however appears to have increased severity of the process and even higher mortality in cases that originated in the perianal region.

The etiologic agent in most cases was Escherichia coli, although in nearly 6 out of 10 cases the infection was polymicrobial, which requires the use of schemes with several antibiotics in initial form, with the subsequent modification of the scheme as findings in the cultures. Despite appropriate treatment, mortality associated with the disease is high, thereby requiring a multidisciplinary and aggressive management, including many of requiring placement in intensive care.

Mortality is directly associated with the index of severity of gangrene. Actas Urol Esp. Gangrena de Fournier". Fournier's gangrene. BJU ; Fournier's gangrene in childrens. Urology ; Enero-Abril Pag Impact of Diabetes Mellitus on the presentation and outcomes of Fournier's Gangrene.

Fournie's Gangrene in a modern surgical setting: Improved Survival with aggressive management. BJU Int ; Outcome prediction in patients with Fournier's Gangrene. July Factors affecting mortality of Fournier's Gangrene: Review of 70 patients.

ANZ J. Fournier's gangrene: experience with 25 patients and use of Fournier's gangrene severity index score. Urology, August 1, ; 64 2 : Fournier's gangrene: Three years of experience with 20 patients and validaty of the Fournier's Gangrene Severity Index Score". Eur Urol, October 1, ; 50 4 : Fournier's gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg.

Eke N. Fournier's gangrene: a review of cases. Br J Surg, June 1, ; 87 6 : Prognostic factors in Fournier gangrene. Int J Urol, December 1, ; 12 12 : Predisposing factors and treatment outcome in Fournier's gangrene.


2010, Número 1

Gray JA. Gangrene of the genitalia as seen in advanced periurethral extravasation with phlegmon. Idiopathic necrotizing fascii tis:recognition, incidence, and outcome of therapy. Ann Surg ; Necrotizing anorectal and perineal infections.


2011, Número 1

Hospital Universitario Dr. Palabras clave: Gangrena de Fournier. Indice de severidad. Fascitis necrotizante. Gangrena genital. It is potentially fatal, and affects any age and gender. The severity index for Fournier's gangrene has been described; it is useful for evaluating the prognosis of these patients.


Fournier gangrene

Diettrich N, Mason J. World J Surg ; Yanar H, Taviloglu K, et al. Ulug M, Gedik E, et al. The evaluation of microbiology and Fournier's gangrene severity index in 27 patients. Acta Chir Belg ;

Related Articles