Fournier’s Gangrene and Its Management-A Prospective Study

Abstract

Background: Fournier’s gangrene is a fatal necrotizing fasciitis of the genitalia and perineum that can lead to infection of the area with various microbes, organ failure, or even death. This study is indented to determine the presence of systemic concomitant diseases, regional risk factors, metabolic problems, early diagnosis, barriers to treatment, and treatment outcomes in Kanyakumari district. Without an accurate diagnosis and prompt treatment, Fournier’s gangrene is a surgical emergency with a high mortality rate. A mortality rate of 15% to 50% has been reported for this polymicrobial necrotizing fasciitis of the vaginal, perianal and perineal regions Aim and Objective: The aim of this study is to determine the age and sex incidence, demographic pattern, predisposing etiologic and risk factors, signs and symptoms, and net patient outcome, and to evaluate the optimal treatment modalities for Fournier’s gangrene. Methods: This study is a prospective observational study conducted in the Department of General Surgery, Kanyakumari Government Medical College from January 2021 to December 2022. A total of 50 cases of Fournier’s gangrene who met the inclusion criteria were included in the study. Demographic data such as age, sex, aetiology, risk factors, clinical features, signs and symptoms, site of infestation, microbial culture, bacterial flora, treatment method used, length of hospital stay, and mortality were examined. Results: A total of 50 patients, 46 men and 4 women, were included in the study. Males outnumbered females in 92% of cases, with a ratio of 11.5:1. Females were found to have vulvar induration and abscess in the perineal or perianal area. In 31 patients (62%), the lesions were located in the scrotum, in 8 patients (16%) in the perineal area, in 6 patients (12%) in the penis, in 3 patients (6%) in the groin, and in 2 patients (4%) in the vulva. Eight individuals in the research group suffered complete scrotal loss. Presentation of symptoms to the hospital was late, averaging 6.8 days after onset. Patients who presented late to the hospital had much more severe morbidity and delayed recovery, requiring multiple debridement and a longer hospital stay. Conclusion: This study suggests that if Fournier’s gangrene is diagnosed early and patients are hospitalized promptly with immediate debridement, metabolic control, and appropriate antibiotics, effective management with a positive outcome is possible. Because the scrotum is a very elastic skin, primary closure and wound healing are possible even after severe necrotic debridement. In patients who have major soft tissue defects after debridement, surgical reconstruction is required, reducing morbidity and hospitalization and allowing patients to return to their normal lives early. Strict metabolic control, proper hygiene, and early treatment are important tools to prevent this devastating disease.