Fournier’s Gangrene: Management Experience

Stroy A.A., Banyra O.B., Micik Yu.O., Lesnyak O.M., Sheremeta R.Z., Shatins'ka-Micik I.S., Shulyak A.V.

Fournier's Gangrene is a fulminating spontaneous necrosis of scrotum. Necrotic process can hit genitalia, peritoneum. Traumatic and infectious etiology. Manifestation is after 2 7 days: acute pain in scrotum, necrosis symptoms. Lethality rates up to 30 40%, directly proportional to affected area. In case of testis involvement lethality rates raise up to 60 90%.

Materials and methods. Fournier's Gangrene manifestation, management and long-term results in 13 cases for a period from 1982 to 2009 were analyzed. Decease severity was determined by Fournier Severity Index (FSI), physical examination, laboratory data, ultrasound investigation, x-ray, CT.

Results and discussion. All 13 patients were hospitalized due to urgent indications. Mean FSI was 9.1 (0-15). Survived patients mean FSI was 8.6, deceased patients 12.4. Physical examination showed that in 6 cases only scrotum was involved, in 4 penis, in 2 abdomen wall, in 1 pelvic tissues. All patients underwent surgery immediately after hospitalization. All necrotic tissues excision is demanded. All patients had a course of antibacterial and disintoxication therapy after surgery with renal function monitoring. 2 patients died on a first day after surgery because of infectious-toxic shock. 9 patients underwent plastic surgery after 1 2 months. Conclusions. Fournier's Gangrene is a fulminating decease demanding urgent radical surgery in first hours of manifestation. Lethality rates are directly proportional to affected area.

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