A retrospective case series of Fournier\u2019s gangrene: necrotizing fasciitis in perineum and perianal region

Nan Zhang,Tongjun Liu,Kai Zhang,Xin Yu

doi:10.1186/s12893-020-00916-3

Abstract

BackgroundTo describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement.MethodsWe retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented.ResultsThere were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits.ConclusionsFournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

Highlights

To describe the clinical characteristics and management for Fournier’s gangrene
Fournier’s gangrene (FG) is a special type of necrotizing fasciitis derived from the skin and subcutaneous tissue infection in perineum or perianal region
FG was diagnosed according to the following points: (1) Characteristic signs of infection, such as fever, gentleness, swelling, erythema with vague boundaries, subcutaneous crepitus, excessive pain, and the expansion of infected area at a maximum pace of 2–3 cm/h. (2) Systemic toxicity signs, for example, high white blood cell (WBC) level (> 15.0 × 109/L), metabolic acidosis with elevated lactate level (> 2 mmol/L), a significant decrease in platelet level (< 100 × 109/L), disseminated intravascular coagulation (DIC) or multiple organ failure (MOF) at the end-stage

Summary

Introduction

To describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement. Fournier’s gangrene (FG) is a special type of necrotizing fasciitis derived from the skin and subcutaneous tissue infection in perineum or perianal region. With the increasing populations of these predisposing factors, the incidence of FG rises . The incidence is still considered to be underestimated because of the insufficient recognition by clinicians. Due to the specific location, FG is usually accompanied by mixed bacteria infections. The infection spreads along the deep fascia, and the lower abdomen or thigh can be involved as the disease progresses. Most patients exhibit systemic infection symptoms, such as high fever and chills, while some may develop septic shock or organ failure

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