Fournier's Gangrene: A Retrospective Clinical Study in a Single Institution

Abstract

Purpose. Fournier's gangrene is a fulminant necrotizing fasciitis, which affects the genital, perianal, and perineal regions. We present a retrospective analysis of the clinical presentation, treatment modalities, and overall mortality of Fournier's gangrene in a single institution. Methods. Records of patients diagnosed with Fournier's gangrene between January 2007 and December 2012 were reviewed. Data on the demographics, medical history, clinical presentation, laboratory studies, treatment modality, duration of hospital stay, and clinical outcomes were analyzed. Results. Atotal of 60 patients (49 males and 11 females) with a mean age of 58.2 14.2 years were identified. The mortality rate was 21.7% (13 cases). Of the 60 patients, 46 underwent surgical debridement and antibiotic therapy, whereas 14 were treated with hyperbaric oxygen (HBO) therapy, surgery, and antibiotics. There was no statistically significant difference in the use of diversion stoma between the survival and non-survival groups (p = 0.421). Old age and septic shock were independent prognostic factors of Fournier's gangrene. Diversion stoma had no influence on the mortality rate of patients with septic shock (42.9% vs. 55.6% with and without stoma, respectively; p = 0.680). However, HBO therapy decreased the mortality rate in patients with septic shock (0.0% vs. 73.3% with and without HBO therapy, respectively; p = 0.001), and in all patients with Fournier's gangrene (0.0% vs. 28.3% with and without HBO therapy, respectively; p = 0.027). Conclusions. These data do not support the routine use of diversion stoma in Fournier's gangrene. HBO therapy appears to provide a survival benefit to these patients.