Number №2, 2016 - page 106-117

Fournier’s gangrene: modern approaches to treatment (literature review)

Prohorov A.V.

Treatment Fournier’s gangrene (FG) is a multidimensional and multidisciplinary; it begins immediately on admission to the surgical ward. Any delay in the initiation of the treatment of FG is associated with a high probability of death due to sepsis and multiple organ failure. The cornerstone in the treatment of FG is emergency surgery combined with a powerful antibacterial and anti-shock therapy. Surgical tactics include multiple sanitary necrectomy using top cuts, opening and drainage abscesses and soft tissue abscesses anogenital region. Taking into account the polymicrobial (aerobic and anaerobic) microflora causative agents of choice of antibiotic therapy FG considered cephalosporins (ceftriaxone) and fluoroquinolones (floksan), aminoglycosides (gentamicin) and metronidazole (metrogil). In severe forms of FG in complex antibacterial therapy include antibiotics from the class of carbapenems (imipenem). Antibiotic therapy is performed immediately after diagnosis at the same time preparing the patient for surgery. Antishock measures designed to maintain hemodynamics, especially in cardiac output, adequate tissue perfusion, to carry out detoxification therapy to reduce the symptoms of endotoxemia. Postoperative wound management process is carried out depending on the phase with the use of different types of wound dressings and methods of pain relief. In the adjuvant treatment of patients with FG and discussed the feasibility of hyperbaric oxygen therapy value, vacuum therapy, as well as various means of influencing wound regenerative process; discusses indications and methods of diversion of feces and urine, various types of reconstructive and plastic surgery. 

Author declare lack of the possible conflicts of interests. 

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Fournier’s gangrene, treatment

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