Cases Of Fournier's Gangrene Research Articles

Fournier gangrene - would you KISS it?

Fournier gangrene is a disease characterized by necrotizing fasciitis of the perineal and genital region, resulting from synergistic polymicrobiotic infection. Most infections can be localized to a cutaneous, urethral, or rectal source and can culminate in a fulminant sepsis. Current state of the art is systemic broad-spectrum antibiotics and serial aggressive debridement which result in superficial perineal defect of wide dimensions. We compiled all the cases of Fournier gangrene that required reconstruction after debridement in Centro Hospitalar Universitário Lisboa Central from 2018 to 2022. Inclusion criteria were reconstruction for Fournier defects and patients' age 18 to 90 years old. Exclusion criteria were patients who didn't require reconstruction or didn't complete it due to death or transfer to another healthcare institution. Reconstructive procedures and complication rates are reported as whole numbers and percentages of total. The initial search yielded 32 patients. There were 2 (6.2%) patients with defects that healed by secondary intention, 6 (18.7%) with delayed primary closure, 4 (12.5%) with implantation of the testicle in a medial thigh pocket, 12 (37.5%) with skin grafts, 4 (12.5%) with scrotal advancement flaps, 2 (6.2%) with flaps, and 2 (6.2%) with flaps and skin grafts in combination. Four outcomes were evaluated: number of patients, defect size, method of reconstruction, and wound-healing complications. Most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. The reconstructive options need to be patient tailored in order to achieve long lasting results with a minimum of postoperative morbidity.

MP20-15 DELAYED PRIMARY CLOSURE OF POST-DEBRIDEMENT FOURNIER'S GANGRENE WOUNDS REDUCES COST

You have accessJournal of UrologyCME1 May 2022MP20-15 DELAYED PRIMARY CLOSURE OF POST-DEBRIDEMENT FOURNIER'S GANGRENE WOUNDS REDUCES COST Andrew Zilavy, Peter Sam, Carolyn Ice, and Maxx Gallegos Andrew ZilavyAndrew Zilavy More articles by this author , Peter SamPeter Sam More articles by this author , Carolyn IceCarolyn Ice More articles by this author , and Maxx GallegosMaxx Gallegos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002553.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Initial management of Fournier's Gangrene (FG) is well established. After complete debridement optimal wound management is evolving. FG wounds are either treated by secondary intention(SI) utilizing negative pressure systems (NPS) or by Delayed Primary Closure (DPC) utilizing flaps and/or grafts. DPC has a shorter length of hospitalization (LOS) and faster return to normal daily activity. We hypothesize that DPC has a lower over all cost the medical system than SI. METHODS: We assessed all cases of FG treated at our hospital system from 2016 to 2021. Patients who died from FG, were lost to follow up or deviated from our treatment protocol were excluded. We collected data regarding LOS, cost of LOS, time utilizing NPS, institution specific KCI NPS cost data from our locoregional KCI representative. A KCI NPS costs $55 per day. Each canister costs $45 and each dressing costs $60. Patients will use about 3 canisters and dressings each week of NPS therapy. Average cost per day of hospitalization is $2,000. RESULTS: 18 cases of DPC and 19 cases of SI met inclusion criteria. DPC average cost of LOS for DPC was $28,600 compared to $42,200 in SI group CI (-26499.85 to -700.15) p <0.05. DPC total NPS therapy cost was $500 compared to $10,305 in SI group CI (-12804.10 to -6805.90) p <0.0001. Cost of surgery for DPC was $6,000. CONCLUSIONS: At our institution, DPC was superior to closure by SI in regards to both cost of LOS and cost of NPS therapy. Patients who underwent SI had an increased total cost of care as compared to DPC patients. Total cost of care, including cost of LOS, cost of NPS therapy and cost of DPC surgery, was increased by $17,405 for SI patients. This increased cost of SI is attributable to the associated increased length of hospital stay and increased length of time on NPS therapy. Multi-institutional prospective data is needed to confirm these findings. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e323 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Zilavy More articles by this author Peter Sam More articles by this author Carolyn Ice More articles by this author Maxx Gallegos More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD29-09 PRIMARY CLOSURE IS SUPERIOR TO SECONDARY INTENTION FOR TREATING FOURNIER GANGRENE

You have accessJournal of UrologyCME1 May 2022PD29-09 PRIMARY CLOSURE IS SUPERIOR TO SECONDARY INTENTION FOR TREATING FOURNIER GANGRENE Peter Sam, Andrew Zilavy, Carolyn Ice, and Maxx Gallegos Peter SamPeter Sam More articles by this author , Andrew ZilavyAndrew Zilavy More articles by this author , Carolyn IceCarolyn Ice More articles by this author , and Maxx GallegosMaxx Gallegos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002577.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Initial management of Fournier Gangrene (FG) is well-established. However, the optimal management post-debridement is still unclear. In general, most post-debridement FG wounds are allowed to heal by secondary intention (SI) with negative pressure wound dressings or treated with delayed primary closure (DPC) using flaps and/or grafts. We hypothesize that DPC is superior to closure by SI in terms of days in the hospital (LOS) and time until return to normal daily activity. Additionally, we hypothesize that DPC is not inferior to SI in terms of infection control. METHODS: At our single tertiary care center, we retrospectively assessed all cases of FG that underwent wound healing by SI vs DPC from 2016 to 2021. A transition to DPC began when our institution hired a GU reconstructive surgeon. Patients who died from their disease, those who were lost to follow up, or those whose closure deviated from our standardized protocol were excluded. Primarily, we collected data regarding LOS and time until return to normal daily activity. Secondarily, we evaluated if DPC or SI resulted in any further need for additional debridement for lack of infection control. T-tests were used to compare our two groups. RESULTS: 18 cases of DPC and 19 cases of SI met inclusion criteria. Patients who underwent DPC spent an average of 14.3 days in the hospital compared to 21.1 days in SI group, CI (-13.23 to -0.37) p <0.05. Time until return to normal daily activity was 43.6 days for the DPC group compared to 103.1 days for SI group CI (-92.14 to -26.86) p <0.005. None of the DPC or SI cases required any debridement beyond the initial 48 hours from presentation. CONCLUSIONS: At our institution, DPC was superior to closure by SI in regards to LOS and time until return to normal daily activity. Patients that underwent DPC enjoyed about 7 less LOS and returned to normal activity about 60 days earlier than patients in the SI group. DPC was non-inferior to SI for infection control. Multi-institutional prospective data is needed to confirm these findings. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e507 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Sam More articles by this author Andrew Zilavy More articles by this author Carolyn Ice More articles by this author Maxx Gallegos More articles by this author Expand All Advertisement PDF DownloadLoading ...

Colostomy for Fournier's Gangrene with Rectum Exposure

Fournier's gangrene (FG) can be treated with prompt surgical debridement. Stoma revision has also been performed to prevent fecal contamination. However, recent advances in stool and wound management have reduced the need for colostomy. We report four cases of severe FG with an exposed rectum and discuss the conditions under which colostomy is indispensable. All four peoples developed FG, and an emergency debridement was performed, resulting in exposure of the rectum. Two peoples with perirectal infectious inflammation extending to the anterior rectum underwent colostomy because the inflammation had reached the retroperitoneum, but the other two, where the inflammation was confined to the dorsal-lateral rectum, were treated successfully without colostomy. We believe that colostomy can be avoided by using suitable wound management devices, except in severe cases where soft tissue infection and necrosis extend to the peritoneum and retroperitoneum and there is concern about rectal ischemia. Number of similar cases published: 0.

Diagnosis and Treatment of Fournier Gangrene in Secondary Hospital; A Report of Two Cases

Fournier Gangrene (FG) is a specific form of necrotizing fasciitis that localized on genital and perianal, although it is rare but it is progressively fast and potentially fatal. The incidence of FG is 1.6 cases per 100,000 males, with a case fatality rate of 7.5%. Proper diagnosis and management are very important to avoid serious complications. Early debridement, broad-spectrum antibiotics and immediate supportive therapy, can reduce mortality. The objective is reporting two cases of FG who were admitted to a secondary hospital and what is the best management based on our setting. The method is qualitative observational study. The material collected through direct interview and from medical record. The best management for our setting was rapid diagnosis and followed by prompt debridement.

Diagnosis and Treatment of Fournier Gangrene in Secondary Hospital; A Report of Two Cases

Fournier Gangrene (FG) is a specific form of necrotizing fasciitis that localized on genital and perianal, although it is rare but it is progressively fast and potentially fatal. The incidence of FG is 1.6 cases per 100,000 males, with a case fatality rate of 7.5%. Proper diagnosis and management are very important to avoid serious complications. Early debridement, broad-spectrum antibiotics and immediate supportive therapy, can reduce mortality. The objective is reporting two cases of FG who were admitted to a secondary hospital and what is the best management based on our setting. The method is qualitative observational study. The material collected through direct interview and from medical record. The best management for our setting was rapid diagnosis and followed by prompt debridement.

Perspectives From a Regional Plastic Surgery Centre on Evidence for the Purported Link Between SGLT2 Inhibitors and Fournier's Gangrene.

Introduction: The recent report issued by the MHRA indicating an association of Sodium glucose linked transporter type 2 (SGLT2) Inhibitors with the contraction of Fournier's Gangrene (FG), has been drawn with insufficient supporting evidence and without an adequately powered study to make any meaningful assertions or recommendations. We aimed to look specifically at the currently available dataset used to link SGLT2 Inhibitors to FG and highlight what conclusions or inferences can meaningfully be made, in particular the power of any study that would be required to make sensible conclusions.Methods: World literature review of SGLT2 Inhibitors and FG was performed. With a subsequent 10-year review of cases of FG seen in a regional burns and plastics centre. Data was collected retrospectively from the coding department at Whiston Hospital for all patients with necrotising fasciitis. An electronic document management system was used to identify patients with FG specifically as well as their diabetes state and medication history.Results: Seventy-eight patients were admitted with FG, of whom 32 had diabetes mellitus (DM). Of those with DM none was taking an SGLT2 Inhibitor, 17 patients were taking metformin, a further nine patients were taking a second line medication and 14 required insulin injections.Discussions: DM is a known major risk factor for FG, which is clearly observed in our patient cohort. The risk of patients with DM developing FG is irrespective of the medication patients are taking. The current articles and reports published have little ground to claim an association between SGLT2 Inhibitors and FG and are missing the crucial message that needs to be conveyed to the public: that DM is a major risk factor for FG and patients suffering with diabetes need to be extra vigilant.

Mortality associated with Fournier's gangrene remains unchanged over 25years.

To report a case series of Fournier's gangrene (FG) from our institution, and to investigate its mortality over the past 25years. Case notes of men presenting to our institution from 2013 to 2016 with FG were reviewed. As well as age, diabetic history, length of stay, length of stay in critical care, and mortality; we calculated (where possible) the Uludag Fournier's Gangrene Severity Index (UFGSI). Published studies and cases series reporting the mortality rates for FG were reviewed from 1993 to 2018. The size of the study, country of origin, average age and gender ratio were collected, alongside mortality. Two of the 11 patients treated for FG at out institution died within 90days of admission, a mortality rate of 18%. Predicted mortality was significantly higher. A total of 173 publications were identified from the Medical Literature Analysis and Retrieval System Online (MEDLINE) database published between 1993 and 2018, reporting data from 1975 to 2018. Analysis of heterogeneity, by both time and precision, supported exclusion of four retrospective coded database-driven studies from the analysis. From the remaining studies, mortality ranged from 0% to 42%. Of the 6152 reported cases, there were 1220 deaths, giving an overall mortality rate of 19.8%. There was no evidence of a significant change in the mortality rate for FG over time (P=0.996). In our case series, the mortality rate for FG was 18%, despite a higher predicated mortality (based on UFGSI scores). The treatment of FG remains appropriate resuscitation, aggressive surgical debridement, and critical care management. Perceived high risk of mortality should not deter aggressive management. Mortality due to FG does not appear to have changed over the past 25years, and is estimated at 19.8%. In studies identifying cases of FG, careful attention should be paid to case definition, particularly when cases are being abstracted retrospectively from large coded databases.

Fournier's gangrene and sodium-glucose co-transporter-2 inhibitors: A meta-analysis of randomized controlled trials.

Fournier's gangrene (FG) is a rare, life-threatening necrotizing fasciitis of the perineum. The US Food and Drug Administration (FDA) released a Drug Safety Communication regarding the risk of FG associated with sodium-glucose co-transporter-2 inhibitors (SGLT2i), relying on the FDA Adverse Event Reporting System. To verify this association, we performed a meta-analysis of all randomized controlled trials enrolling patients with type 2 diabetes, comparing SGLT2i with placebo or different therapies, collecting cases of FG reported as a serious adverse event. Risk of abscess, cellulitis and erysipela were secondary outcomes. We retrieved 84 trials enrolling 42 415 patients in the SGLT2i group and 27 158 patients in comparator groups. No difference was observed between SGLT2i and comparators in the risk of FG (Mantel-Haenzel odds ratio [MH-OR] 0.41 [0.09, 1.82]), abscess (MH-OR 0.94 [0.54, 1.65]), cellulitis (MH-OR 0.90 [0.71, 1.13] or erysipela (MH-OR 0.89 [0.45, 1.77]). The number of events was small, leading to a wide confidence interval that does not allow ruling out an increase in FG or skin and subcutaneous tissue infections.

Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases.

Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors has been associated with Fournier gangrene (FG), a rare urologic emergency characterized by necrotizing infection of the external genitalia, perineum, and perianal region. To describe and compare reported cases of FG in diabetic adults receiving treatment with SGLT2 inhibitors or other antiglycemic agents. Descriptive case series. U.S. Food and Drug Administration (FDA) Adverse Event Reporting System and published case reports. Adults receiving SGLT2 inhibitors or other antiglycemic agents. Clinical and laboratory data. The FDA identified 55 unique cases of FG in patients receiving SGLT2 inhibitors between 1 March 2013 and 31 January 2019. The patients ranged in age from 33 to 87 years; 39 were men, and 16 were women. Time to onset after initiation of SGLT2-inhibitor therapy ranged from 5 days to 49 months. All patients had surgical debridement and were severely ill. Reported complications included diabetic ketoacidosis (n= 8), sepsis or septic shock (n= 9), and acute kidney injury (n= 4). Eight patients had fecal diversion surgery, 2 patients developed necrotizing fasciitis of a lower extremity that required amputation, and 1 patient required a lower-extremity bypass procedure because of gangrenous toes. Three patients died. For comparison, the FDA identified 19 FG cases associated with other antiglycemic agents between 1984 and 31 January 2019: metformin (n= 8), insulin glargine (n= 6), short-acting insulin (n= 2), sitagliptin plus metformin (n= 2), and dulaglutide (n= 1). These patients ranged in age from 42 to 79 years; 12 were men, and 7 were women. Two patients died. Inability to establish causality or incidence, variable quality of reports, possible underreporting, and confounding by indication. FG is a newly identified safety concern in patients receiving SGLT2 inhibitors. Physicians prescribing these agents should be aware of this possible complication and have a high index of suspicion to recognize it in its early stages. None.

Less is more? Antibiotic duration and outcomes in Fournier's gangrene.

Antibiotic management of Fournier's gangrene (FG) is without evidence-based guidelines and is based on expert opinion. The effect of duration of antibiotic therapy on outcomes in FG is unknown. A retrospective review was performed of FG patients from 2012 to 2015 at a single institution. Patients were managed by our institutional practice of complete primary wound closure as possible, with antibiotic duration according to physician judgment. Patients were stratified into multiple durations of antibiotic administration. Overall, 168 patients with FG were included. When examining multiple stratifications of antibiotic therapy of 7 days or less, 8 days to 10 days, 11 days to 14 days, or 15 days or more of antibiotics, there was no significant difference in mortality (p = 0.11), primary closure (p = 0.75), surgical site infection (SSI) (p = 0.52), or Clostridium difficile infection (p = 0.63). There were no cases of recurrent FG in any antibiotic stratification. Mortality was not increased (p = 1.00) and ability to achieve primary closure was not decreased (p = 0.08) with initial antibiotic therapy exclusive of cultured organisms. Shorter antibiotic courses for patients in whom source control is obtained and initial antibiotic selection exclusive of many resistant organisms were not associated with worse outcomes in FG. Therapeutic, level IV.

Hyperbaric Oxygen Therapy as an Adjuvant Therapy for Comprehensive Treatment of Fournier's Gangrene

Objectives: To compare simple conventional treatment with the addition of hyperbaric oxygen therapy (HBOT) to conventional therapies in the treatment of Fournier's gangrene (FG). Methods: A retrospective study of clinical data was performed by reviewing 28 cases of FG from January 2004 to December 2013 at Xiangya Hospital, Central South University. Among them, 12 patients were treated with the conventional therapy (non-HBOT group) and the other 16 cases were combined with hyperbaric oxygen therapy besides conventional therapy (HBOT group). All patients were followed up for 2 months to assess the therapeutic effect. The analyzed data included age, Fournier gangrene severity index (FGSI) score, number of surgical debridement, indwelling drainage tube time, length of stay (LOS), effective time, and curative time. Results: The mortality rate was lower in the HBOT group at 12.5% (2/16) compared to the non-HBOT group, which was 33.3% (4/12). The difference in the number of surgical debridement, indwelling drainage tube time, and curative time between were significantly lower in the HBOT group compared to the non-HBOT group. Conclusions: Our preliminary research suggests that the effect of combining hyperbaric oxygen therapy with conventional therapy offers considerable advantage in the management of Fournier's gangrene. Multicenter studies with a larger sample size are required to confirm these observations.

Fournier's Gangrene: Report of 2 Cases

Fournier's gangrene is a very serious surgical emergency seen all over the world. With the newer advancement of surgical techniques and critical care medicine, the mortality and morbidity of this disease has come down significantly over a period of time. An early diagnosis including evaluation of predisposing and etiological factors, metabolic and physiological parameters with prompt resuscitation, aggressive surgical debridement, broad-spectrum antibiotic coverage, and continuous monitoring of all the parameters is essential for a good outcome, therefore reducing the high mortality and morbidity of this condition. In this study, we report 2 different cases of Fournier gangrene. Our first case was a young, nondiabetic, and without any multiorgan failure, who was managed successfully with good outcome. The second case was a 67-year-old man with diabetes and multiorgan dysfunction with extensive gangrene at presentation, who recovered well, but with a stormy postoperative period.