Surgical Management of Fournier's Gangrene

Baek, Jeong Heum; Yoon, Sang Jin; Oh, Jae Hwan

Abstract

PURPOSE: Fournier's gangrene is a potentially fatal infectious necrotizing fasciitis of the scrotum, penis, and perineal region. If not recognized early, this process will extend along the fascia plane to the lower abdominal and back regions, causing severe morbidity and even mortality. The aims of this study were to investigate the clinical characteristics and to evaluate the outcome of our experience with 16 cases of Fournier's gangrene.
METHODS
Clinical data from 16 patients with the diagnosis of Fournier's gangrene, who were treated at Gil Medical Center from January 1995 until October 2001, were analyzed retrospectively.
RESULTS
The patients consisted of 14 men and 2 women, with an average age of 62 years. The potential ports of entry for the causative bacteria included the anorectum (75.0%), the urinary tract (18.8%), and the skin (6.3%). Predisposing factors included diabetes mellitus (62.5%), alcoholism (6.3%), steroid use (6.3%), malignancy (6.3%), and ulcerative colitis (6.3%). Escherichia coli and Staphylococcus aureus were most commonly identified in bacterial cultures. All patients were treated with a broad spectrum antibiotics and serial surgical debridement. Twelve patients had fecal diversions, and five patients had urinary diversions. Three patients underwent orchiectomies. One patient (6.3%) died due to sepsis.
CONCLUSIONS
The management of this infectious entity should be aggressive with early recognition. Patients with Fournier's gangrene need prompt extirpation of all nonviable tissue and a cystostomy or a colostomy when necessary. A broad-spectrum antimicrobial regimen and aggressive debridement are mandatory.