Fournier's Gangrene: 10-Year Experience of a Plastic Surgery and Burns Department at a Tertiary Hospital.

Abstract

Fournier gangrene is a polymicrobial life threatening infection of perineal subcutaneous soft tissues with its point of originin urologic, colorectal or skin diseases. Although more frequent in elderly and men, it can affect all genders and age groups. Perianalabscess, diabetes mellitus and Escherichia coli are the most frequent cause, predisposing comorbidity, and microorganism found intissue culture analysis respectively. The objective of this study was to describe the experience of a Plastic Surgery Department of atertiary Hospital in reconstructing Fournier's gangrene perineal defects and its detailed demography. The sample is composed of all patients with Fournier gangrene admitted in the Plastic Surgery and BurnsDepartment. The authors retrospectively collected and analyzed demographic and clinical data during a period of 10 years includinggender, age, length of stay, cause, number of debridements, predisposing factors, microbial culture results, surgical reconstructivetechniques and its associated complications, additional surgical procedures and outcomes. Fifteen patients were identified: 14 males (93%) and one female (7%); mean age was 66.9 years (range: 46 - 86); mean,length of stay was 46.8 days (range: 20 - 71 days) and mean number of debridements was 3.3 (range: 1 - 4). The most frequent predisposing factor was diabetes mellitus, the major cause was perianal (n = 2) and skin abscess (n = 2). Eight (53.3%) patients had no identifiable source of Fournier gangrene. Various types of reconstructive techniques were employed; and 5 additional surgical interventions(33.3%) were undertaken (one cystostomy, two orchidectomy, two ileostomy); six patients (40%) presented reconstructive techniquecomplications with adequate final outcome. In contrast with the literature, where Escherichia coli was the most frequently isolated agent, Staphylococcus aureus wasthe most frequent microorganism found in tissue biopsy/pus collection analysis. A higher than expected number of patients (n = 8) hadno identifiable source of Fournier gangrene. This findings can be explained by the retrospective non-multicentre study limitation, witha potencial source of bias patients that were transferred from other hospitals in advanced stage, without point of origin of Fournier'sgangrene identified. Early recognition and extensive necrotic tissue debridement, along with prompt and adequate antimicrobial treatment, arethe mainstay of Fournier gangrene management, thus reducing morbidity and mortality in these patients. Surgical reconstruction challenges derived from this condition should be addressed by specialized teams due to the risk of dysfunctional sequelae and conspicuousdeformities. Taking in account the single-center and retrospective observational character of the present study, these premises requireproper validation from a multicenter prospective study.