Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier's gangrene: Usefulness of a severity index score in predicting disease gravity and patient survival

Abstract

IntroductionHyperbaric oxygen therapy (HBOT) concomitant to surgery has been reported to reduce Fournier's gangrene (FG) mortality compared to exclusive surgical debridement. Most report from centers with relatively few patients using only surgical procedure. To assess efficiency of aggressive debridement with adjunctive HBOT. To evaluate Fournier's gangrene severity score index (FGSI) predictive value. Material and methods70 Fournier's gangrene (FG) treated by surgical debridement and HBOT. Data were evaluated for physical examination findings, admission and final laboratory tests, surgical debridement extent, and antibiotic used. Patients had adjunctive (HBOT). FGSI, developed to assign a score describing the acuity of disease, was used. This index presents patients’ vital signs and metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, and white blood cell count) and computes a score related to the severity of disease at that time. Data were assessed accordingly whether the patient survived or died. All patients underwent surgical debridement. Wound debridement was regularly performed in the postoperative period. ResultsOf 70 patients, 8 died (11.4%) and 62 survived (88.5%). Difference in age between survivors (median age, 50.0yr) and non-survivors (median age, 54.5yr) was not significant (p=0.321). Median extent of body surface area involved in necrotizing process in patients who survived and did not survive was 2.4% and 4.9%, respectively (p=0.001). Except for albumin, no significant differences were found between survivors and non-survivors. Median admission FGSI scores for survivors and non-survivors were 2.1±2.0 and 4.2±3.8 (p=0.331). ConclusionFGSI score did not predict disease severity and the patient's survival. Metabolic aberrations and extent of disease seemed to be important risk factors for predicting FG severity and patient survival.