Surgical management of Fournier gangrene

Abstract

Background: Fournier's gangrene (FG) is a debilitating type of infective necrotizing fascitis of the perineal, genital, or perianal regions. Despite the rarity of this disease, unfavorable ­prognosis related to this disease depends much on the timing of medical care. Hence; the present study was undertaken for assessing and summarizing data of surgical management of 30 patients of Fournier gangrene. Materials & methods: Thirty patients who presented with clinical signs and symptoms suggestive of FG were enrolled. Emergency debridement of all the patients was carried out under the cover of broad spectrum antibiotics. Tissue samples were subjected to analysis for culture and antibiotic sensitivity testing. At the time of first debridement, hydrogen peroxide was used, followed by Eusol dressings until slough had separated. This was followed by Povidone Iodine dressings until the wound was healthy and ready for graft. Fournier’s Gangrene Severity Index (FGSI) was assessed. Surgical management procedures employed were recorded separately and follow-up was done. Results: Mean age of the patients was 58.4 years. Diabetes was found to be present in 66.67 percent of the patients. Mean FGSI score was found to be 3.96. Mean number of debridements was found to b 4.69. Fever, scrotal pain and headache were the most common symptoms encountered in the present study. Mean duration of hospital stay was 30.1 days. Partial thickness skin grafting was done in 36.67 percent of the cases while thigh pouch reconstruction was done in 20 percent of the cases. Secondary suturing was done in 53.33 percent of the cases. Multiple additional incisions on inguinal region and psoas for draining abscess were done in 12 patients. Mortality was nil in the present study. Conclusion: Adequate debridement along with surgical therapy results in significant favorable outcome in FG patients. Also, mortality can be significantly reduced by achieving with rapid diagnosis and carrying out urgent surgical debridement of all necrotic tissues under cover of adequate antimicrobial therapy.