Hyperbaric Oxygen Therapy in Extensive Fournier's Gangrene-our Experience of Treatment

Abstract

Fournier's gangrene is a fulminant necrotizing fasciitis of the perineum and a lethal disease. Obliterative endarteritis, caused by the pathogens, blocks the circulation, impairs tissue perfusion, and then causes gangrene and necrosis of the skin and fascia. The pathogens rapidly proliferate along the necrotic fascia and skin, leading to serious infection and sepsis. The mortality rate of patients with Fournier's gangrene with extensive lesions is higher than that for patients with localized lesions. Old age, trauma, diabetes, immunosuppression, and chronic systemic diseases are predisposing factors. Sepsis is the most important factor of mortality. The principles of treatment include eradicating the bacteria and blocking the progress of extensive Fournier's gangrene. Eradication of bacteria includes use of broad-spectrum antibiotics, wound debridement, drainage and frequent dressing changes. Blockage of the progress of necrotizing fasciitis can be done by increasing tissue oxygenation. Hyperbaric oxygen therapy is a good modality to increase tissue oxygen and, therefore, improves the outcome. However, the clinical effects of hyperbaric oxygen therapy are controversial. We present our clinical experience with hyperbaric oxygen therapy in extensive Fournier's gangrene.