Fournier's Gangrene Research Articles

Delta neutrophil index as a prognostic factor for mortality in patients with Fournier's gangrene.

The delta neutrophil index represents the fraction of circulating immature granulocytes and is a marker of infection and sepsis. Our study aimed to evaluate the usefulness of the delta neutrophil index in predicting mortality in patients with Fournier's gangrene. We enrolled patients with Fournier's gangrene who were admitted to the Wonju Severance Christian Hospital (Wonju, Korea) between September 2010 and December 2021. We retrospectively analyzed the patients' characteristics, factors related to management, scoring systems such as the Fournier's Gangrene Severity Index, and laboratory data measured at initial presentation. There were 58 (68.2%) survivors and 27 (31.8%) non-survivors. The initial levels of serum lactate, hemoglobin, delta neutrophil index, albumin, international normalized ratio, creatinine, Fournier's Gangrene Severity Index, Uludag Fournier's Gangrene Severity Index, and prognostic nutritional index differed between survivors and non-survivors. Age, international normalized ratio, and delta neutrophil index were independent predictors of mortality in Fournier's gangrene. In receiver operating characteristic curve analysis, delta neutrophil index on the day of admission was the best indicator of mortality (area under the curve, 0.804; 95% confidence interval [0.679-0.929]). The optimal cutoff for delta neutrophil index in predicting mortality was 11.25% (sensitivity, 74.1%; specificity, 91.4%). The initial delta neutrophil index was the best indicator of mortality (area under the curve, 0.804; 95% confidence interval 0.679-0.929). The delta neutrophil index can be useful for predicting mortality in patients with Fournier's gangrene. A delta neutrophil index >11.25% at initial presentation is a reliable predictor of Fournier's gangrene.

Clinical study of Fournier’s gangrene tertiary care center government medical college, Nizamabad

Background: Fournier's gangrene (FG) is fast-spreading necrotizing gangrene that affects the perineum, perianal, and genital regions, but spares the testicles, bladder, and rectum due to their independent blood supply from the aorta. The purpose of this research is to share our experience managing 32 cases. Patients and method: Between April 2018 and May 2022, researchers from Government Medical College in Nizamabad conducted a prospective cross-sectional study of patients with FG. During the study period, all individuals diagnosed with FG and treated for it were included. Age, sex, hospital stay, premorbid conditions, mobility, mortality, laboratory examinations, and therapies performed are among the data collected from these. Results: A total of 38 patients were seen throughout the study, with four patients being eliminated due to missing data, leaving 32 patients for the final analysis. With a male to female ratio of 15:1, there were 30 (93.75%) males and 2 (6.25%) females.

Cutaneous Anomalies of the Critically Ill Patient.

Critically ill patients are at high risk for organ failure, including that of the integumentary system. Nurses working in intensive care are adept at performing comprehensive assessments that include the skin. Although pressure injury is a well-known complication associated with critical illness, patients may also have debilitating and life-threatening dermatoses. Conditions such as skin failure and medical adhesive-related skin damage are commonly seen in the critically ill. Infectious processes, such as Fournier gangrene, invasive candidiasis, mucormycosis, and herpetic lesions, can result in severe or superimposed critical illness and elude detection. Similarly, cutaneous manifestations of COVID-19 may develop prior to commonly recognized symptoms of infection. Nurses and providers caring for critically ill patients should be aware of common, but less widely known, skin conditions to facilitate early detection and treatment.

Necrotizing Fasciitis: Evaluation of 85 Cases and Usage of LRINEC Score.

The present study aims to define the characteristics of the necrotizing fasciitis (NF) cases followed at our hospital and to compare our results with the literature. In this study, NF cases followed and treated at our hospital from January 2005 to April 2019 were evaluated retrospectively. A total of 85 cases of NF were included in the study. Of the cases, 33 (39%) were female and the median age was 59.8±13.1 years (range: 26-92 years). Diabetes mellitus (DM) (56%) was the most prevalent comorbid condition. Extremities were the most frequently involved field found in 41 (48%) of the cases followed by Fournier's gangrene found in 34 (40%) of the cases. All of the cases had undergone surgical intervention (debridement and/or amputation) and received broad-spectrum antibiotic therapy. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score was calculated for 60 cases, and it was 6 or higher in 78% of them. Nineteen (22%) of 85 cases had died. Necrotizing fasciitis affects generally older male patients with DM. In NF cases to avoid the higher risk of mortality, the removal of necrotic tissue via surgical procedure together with antimicrobial therapy is required urgently; therefore, it is very important to differentiate NF from soft tissue infections as soon as possible. As the LRINEC score predicted NF among nearly 80% of our patients, this score could be used as an early diagnostic tool of NF. Level IV, case series.

Management of Secondary Perineal abscess with Impending Fournier's Gangrene by Incision and Drainage with Surgical Debridement in an Operated Case of Perianal Abscess - A Case Report

Management of Secondary Perineal abscess with Impending Fournier's Gangrene by Incision and Drainage with Surgical Debridement in an Operated Case of Perianal Abscess - A Case Report

Fournier's Gangrene, an Exceptional Complication of Appendecto My Case Report

Fournier's gangrene is a fasciitis of the perineum, due to an acute bacterial infection necrotic bacterial infection of the soft parts of the perineum, by aerobic and anaerobic germs, with a severe prognosis with spontaneous evolution towards visceral failure and death. Although its etiologies remain unresolved, the urinary and anal outlets remain the main entry point. We report in this article an exceptional complication of an appendectomy in a 50-year-old non-diabetic patient whose immediate postoperative course was marked by the development of a Fournier’s gangrene.

39 - Fournier gangrene predictors of mortality - single centre experience.

39 - Fournier gangrene predictors of mortality - single centre experience.

Fournier gangrene with concurrent multifocal necrotizing fasciitis: a systematic review and case report.

A patient presented to a regional surgical center with Fournier gangrene (FG) and concurrent multifocal necrotizing fasciitis (NF). Given the rarity, it was decided to undertake a systematic review to investigate the incidence and prevalence of FG with multifocal NF and consequently determine the treatment and approach to management of such presentation. Firstly, the report of the 56-year-old male patient is discussed regarding his surgical management. Secondly, a systematic review was undertaken according to PRISMA guidelines using MEDLINE, Scopus, and Embase databases. Searches used the following MeSH terms: ("fournier's gangrene") AND ((necrotising fasciitis) OR (necrotising soft tissue infection)). Once the search results were obtained, duplicate articles were removed. Titles, abstracts, and articles were reviewed by 2 authors. The search strategy using the 3 databases revealed a total of 402 studies. Fifty-seven studies were removed due to duplication. A total of 345 records were screened via title and abstract, of which 115 were excluded. Two hundred and thirty studies were reviewed for eligibility. A total of all 230 studies were excluded; 169 were excluded as they included the incorrect patient population (patients suffered from FG or NF, but not both collectively), 60 studies were excluded due to incorrect study designs, and 1 report occurred in the wrong setting. This highlights that while being a relatively known, uncommon infection both FG and NF are well documented separately within the literature. However, FG with concurrent multifocal NF has not been documented within the literature.

Rectal cancer as a rare cause of Fournier's gangrene

Rectal cancer as a rare cause of Fournier's gangrene

Fournier's Gangrene under Sodium-Glucose Cotransporter-2 Inhibitors Therapy in Gynecological Patients.

Fournier’s gangrene (FG) is a serious pathology of the soft tissues and fascia of the perineum and genital region with a high morbidity and mortality rate. In recent years, the SGLT-2 inhibitor oral antidiabetic has been related to this entity. According to the new warnings from the main drug agencies, a compilation of cases has been initiated to establish or deny a possible causal relationship. Most of these cases have been reported in men. However, it is important not to underestimate this entity in the gynecological field, since it is extremely serious and requires intense and rapid aggressive treatment based on surgery and empiric antibiotherapy. Later, some cares are needed to involve surgical reconstruction of the defects introduced by debridement. As a result of the low incidence of FG, clinical trials’ data may be insufficient to robustly assess this issue because of the limited numbers of participants. Real-world evidence may help to clarify the association between SGLT2i and FG. The aim of this review is to describe and compare the reported cases of GF in diabetic women who received SGLT2 inhibitors as antiglycemic agents.

Distinctions between Fournier's gangrene and lower extremity necrotising fasciitis: microbiology and factors affecting mortality

ObjectivesIn this study, we aimed to illustrate distinctions between Fournier's gangrene (FG) and lower extremity necrotising fasciitis (NF) and screen out possible risk factors of poor prognosis for each cohort. MethodsThe medical records of qualified patients with NF admitted to the Second People's Hospital of Yibin from January 2016 to June 2021 were retrospectively reviewed. All participants were anatomically categorised into FG and lower extremity NF groups, and their baseline data and microbiological results were compared. Further comparisons of critical parameters were conducted between survivors and nonsurvivors within each group. ResultsA total of 49 patients were included in the study with a median age of 58 years, and overall mortality was 20.4%. There were 18 patients with FG and 31 patients with lower extremity NF. A microbiology distinction was found—the predominance of gram-negative infection in FG and gram-positive infection in lower extremity NF. High Fournier's gangrene severity index scores (greater than 7), advanced age, procalcitonin and D-dimer value were identified as risk factors for FG, and the presentation of sepsis was an alarming indicator for lower extremity NF. ConclusionsThe distinction of microbiology might provide advice for appropriate antibacterial administrations. In addition, with practical prognostic predicting tools, clinicians might be able to identify patients at increased risk and intervene promptly to avoid unfavourable outcomes.

Management of Fournier’s Gangrene at postgraduate medical institute Sandeman provincial Hospital Quetta

BACKGROUND & OBJECTIVE: Fournier's Gangrene is a quick development of necrotizing, fulminant infection of the scrotum, perineum, and lower abdominal wall and can involve the groin. Synergic aerobic and anaerobic organisms can cause this disease. The aim of this study is to evaluate the causes, complications and optimal treatment of Fournier’s Gangrene.
 METHODOLOGY: A total of 150 patients were included. Fournier’s Gangrene was diagnosed clinically. Detailed clinical examination was performed, and the complications and modes of treatment were recorded. Calculation of descriptive statistics was done by the stratification and application of independent T-test and Chi-square test wherever applicable for post-stratification, considering p-value ≤0.05 as significant.
 RESULTS: The mean age was 31.74±6.24 years. The most common presenting complaint was the dusky appearance of the overlying skin. In the diabetic group, (66)44% had intense genital pain and tenderness, while in the non-diabetic group (72)48% observed a dusky appearance of the overlying skin and (37)24.7% had morbid obesity. No significant association was found between mortality of study groups, their age groups and their duration of hospital stay.
 CONCLUSION: Most common presenting complaint was the dusky appearance of the overlying skin. The anal abscess was the most common etiology, followed by a strangulated inguinal hernia. The mortality rate was 24%.

Favorable Outcomes With Early Component Separation, Primary Closure of Necrotizing Soft Tissue Infections of the Genitalia (Fournier's Gangrene) Debridement Wound Defects

ObjectiveTo evaluate the efficacy of early necrotizing soft-tissue infections of the genitalia (NSTIG) component separation, primary wound closure (CSC). We hypothesized that early CSC would be safe, decrease the need for split-thickness skin grafting (STSG) and decrease wound convalescence time. Materials/MethodsManagement of consecutive NSTIG patients from a single institution were evaluated. Three cohorts emerged: 1) those managed/closed by a reconstructive urologist (URO) using CSC principles (wide genital tissue mobilization with primary closure, when possible, +/- STSG), 2) those managed/closed by the general surgery/burn service, and 3) those managed conservatively with secondary closure. Total NSTIG anatomic extent (AE) was determined by assessing involvement of the penis, scrotum, perineum and suprapubic region, and ranged from 1 (<50% involvement of one area) to 8 (>50% involvement in all 4 areas). ResultsOf 84 FG patients meeting study criteria, 48 (57%) were closed primarily and 36 were left to heal by secondary intention. AE was greatest in patients managed by general surgery/burn service (4.5 ± 1.5), followed by URO (2.7 ± 1.8) and secondary intention cases (1.3 ± 0.5). Secondary procedure rates were similar between closure/non-closure cohorts (6.3% v 11%; P = 0.67). STSG use was predicted by wound size (though not time to closure)-specifically with suprapubic and/or penile wounds of >50% involvement. Wound convalescence time decreased by 64% when wounds were closed versus left open, controlling for AE. ConclusionEarly, same-admission primary closure of stable NSTIG wounds is safe and decreases wound convalescence time by over 60%.

Sodium-glucose cotransporter-2 (SGLT-2) inhibitor-induced diabetic ketoacidosis and Fournier's gangrene

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

An inaugural diabetic ketoacidosis revealed by Fournier's gangrene

An inaugural diabetic ketoacidosis revealed by Fournier's gangrene

MP37-20 OUTCOMES AND HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN LONG-TERM SURVIVORS OF FOURNIER’S GANGRENE

You have accessJournal of UrologyCME1 May 2022MP37-20 OUTCOMES AND HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN LONG-TERM SURVIVORS OF FOURNIER’S GANGRENE Laila Schneidewind, Vanessa Roßberg, Desiree L. Dräger, Joachim Steffens, Oliver W. Hakenberg, and Jennifer Kranz Laila SchneidewindLaila Schneidewind More articles by this author , Vanessa RoßbergVanessa Roßberg More articles by this author , Desiree L. DrägerDesiree L. Dräger More articles by this author , Joachim SteffensJoachim Steffens More articles by this author , Oliver W. HakenbergOliver W. Hakenberg More articles by this author , and Jennifer KranzJennifer Kranz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002591.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fournier's gangrene (FG) is a sporadic, life-threatening, necrotizing infection affecting the perineum, perineal region and genitals. Unfortunately, FG has a poor prognosis, which has not improved in recent years. As the incidence is low, data about outcomes and quality of life in long-term survivors of FG are lacking. Consequently, we performed a multicentric study with the primary aim to describe health-related quality of life (HRQoL). METHODS: We retrospectively identified male patients treated for FG via ICD-10 coding in two centers (one university medical center and one tertiary care center) from January 2010 to December 2020 (ten years). Patients who survived the inhouse treatment were invited to participate in a survey including the validated questionnaires International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), Quality of Life in chronic wounds (WOUND-QoL), Freiburger Life Quality Assessment – wound module (FLQA-w) and the Short Form Health (SF-36). RESULTS: Finally, 39 patients with a median age of 65.0 years (IQR 53.0 – 74.0) at therapy for FG were identified. Twenty patients were already dead (51.3%), nine patients were lost to follow up (23.1%), and ten patients participated in the survey (25.6%). The median survival time was 27.0 months (IQR 9.0 – 60.0). In eight patients (one of the ten had a suprapubic catheter and one practiced self-catheterization) the median IPSS was 13.5 (IQR 4.3 – 22.3), five patients (50.0%) had severe erectile dysfunction. On the whole, three patients (30.0 %) reported problems with the wound, two (20.0%) complained about wound pain and one (10.0%) about the wound healing situation. The mean global health score in WOUND-QoL was 1.83 (SD 1.1), which is significantly less than in the German reference population (p<0.0001). In the FLQA-w the mean subscales were for physical aliment 1.8 (SD 1.1), everyday life 1.5 (Sd 0.5), social life 1.6 (SD 0.8), psychological well-being 1.8 (SD 1.2) and satisfaction in different areas of life 1.9 (SD 1.0), respectively. The mean general health score in SF-36 was 64.0 (SD 10.5). Interestingly, age over 70 years is not significantly associated with worse reported outcomes in all subscales of used questionnaires. CONCLUSIONS: In long-term survivors of FG the wound situation has a deeply negative impact on HRQoL. This impact seems not to be age-dependent. Further research is essential to ensure the quality of care. Source of Funding: Institutional © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e617 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laila Schneidewind More articles by this author Vanessa Roßberg More articles by this author Desiree L. Dräger More articles by this author Joachim Steffens More articles by this author Oliver W. Hakenberg More articles by this author Jennifer Kranz More articles by this author Expand All Advertisement PDF DownloadLoading ...

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 ...

The "Sombrero-Shape" Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene.

When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name “sombrero” as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months' follow-up. The ALT flap design “sombrero” modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure.

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

Addressing Health Concerns Interrupted by the COVID-19 Pandemic