Fournier's Gangrene Research Articles

Neutrophil-lymphocyte ratio and fournier gangrene severity index are not prognostic factors of mortality in fournier gangrene patients

Background Fournier gangrene (FG) is a life-threatening disease, commonly found in diabetic and immunocompromised patients. Recent studies suggested the use of new parameters apart from the commonly used Fournier gangrene severity index (FGSI), such as the neutrophil-lymphocyte ratio (NLR), the clinical use of which remains questionable. Therefore, we aimed to evaluate the role of the NLR and FGSI as a prognostic factor of mortality in patients with FG. MethodsThis is an analytical study with a retrospective approach involving 109 adult patients diagnosed with FG. Data were collected regarding medical history, symptoms, physical examination findings, and laboratory tests. The FGSI score and NLR were determined. Bivariate analysis was performed using chi-square test and independent t-test. Overall survival between groups was compared using Kaplan–Meier survival estimates and Cox regression test. ResultsOf the 109 patients, 90 survived (82.5%, group 1) and 19 died (17.43%, group 2). The cut-off point of NLR among the patients was 10.9, with a 73.7% sensitivity and 60% specificity. The area under curve value was 0.65 (95% CI; 0.524-0.754; p<0.05). The Kaplan Meier survival analysis showed that NLR was as an independent prognostic factor of mortality in FG patients (HR 5.177; 95% CI; 1.092-8.471; p<0.05), but Cox regression analysis showed that NLR and FGSI were not significant prognostic factors of mortality (p=0.09 and p=0.179; respectively). ConclusionThis study demonstrated that NLR and FGSI are not important as prognostic tools for FG mortality.

Risk Factors and Interventions: Fournier Gangrene in a Tertiary Hospital: A 10-year Experience

Objective. The study aimed to describe the patient demographic characteristics, clinical factors, surgical interventions, and quality of care parameters in non-survivors and survivors of Fournier’s gangrene (FG).
 Methods. A total of 131 cases of Fournier’s gangrene (FG) were included in a retrospective chart review in the Philippine General Hospital over 10 years using the Department of Surgery research database. We collected data for various direct and derived variables from the identified population. The primary outcome was mortality rate, while other factors studied were genital and colorectal manipulation, bowel diversion, laboratory parameters (white blood cell count, creatinine, hemoglobin).
 Results. The mortality rate was 15%. Diabetes mellitus was common comorbidity among patients with Fournier’s disease. The following were statistically more common in the non-survivor group: female sex, concomitant bowel diversion surgery. Admission data in the non-survivor group showed a lower serum hemoglobin, a higher serum creatinine, and an increased percentage of patients with an abnormal white blood cell count; these did not statistically differ between cohorts, however. The median time to first antibiotic infusion was six hours. The median time to surgery was 13 hours.
 Conclusions. Among patients with Fournier’s gangrene, the proportion of women and those undergoing bowel diversion was higher in those who did not survive. The time of infusion of antibiotics or time to surgery did not differ significantly between survivors and non-survivors.

Which Role for Hyperbaric Oxygen Therapy in the Treatment of Fournier's Gangrene? A Retrospective Study.

PurposeIn Fournier's gangrene, surgical debridement plus antimicrobial therapy is the mainstay of treatment but can cause a great loss of tissue. The disease needs long hospital stays and, despite all, has a high mortality rate. The aim of our study is to investigate if factors, such as hyperbaric therapy, can offer an improvement in prognosis.MethodsWe retrospectively evaluated data on 23 consecutive patients admitted for Fournier's gangrene at the University Hospital “P. Giaccone” of Palermo from 2011 to 2018. Factors related to length of hospital stay and mortality were examined.ResultsMortality occurred in three patients (13.1%) and was correlated with the delay between admission and surgical operation [1.7 days (C.I. 0.9–3.5) in patients who survived vs. 6.8 days (C.I. 3.5–13.4) in patients who died (p = 0.001)]. Hospital stay was longer in patients treated with hyperbaric oxygen therapy [mean 11 (C.I. 0.50–21.89) vs. mean 25 (C.I. 18.02–31.97); p = 0.02] without an improvement in survival (p = 1.00).ConclusionOur study proves that a delay in the treatment of patients with Fournier's gangrene has a correlation with the mortality rate, while the use of hyperbaric oxygen therapy seems to not improve the survival rate, increasing the hospital stay instead.

Self-reported Post-vasectomy Fournier's Gangrene Complication Among Practitioners

ABSTRACT Introduction While several cases of Fournier's gangrene have been reported following vasectomy, the prevalence of this complication is yet to be elucidated. Objective Determine the prevalence, presentation and outcome of Fournier's gangrene post-vasectomy. Methods We developed a brief IRB exempt survey that was disseminated by email to the 250 high volume vasectomy practitioners who are part of a global networking list-serve to gather prevalence, presentation and outcome of this debilitating complication. The data was organized and analyzed via Microsoft Forms and Excel. Results 83/250 members responded to the survey (33%).Practitioners were: family practitioners 74.6% (62), urologists 19.2% (16), general surgeons 3.6% (3), internist 1.2% (1) and 1 Ob/Gyn. The mean self-reported number of vasectomies performed per provider was 574. 8.4% (7) of all practitioners routinely provide antibiotics prior to the procedure. The self-reported complication rate for Fournier's gangrene in this population was 6% (5). Of which majority noted the typical clinical presentation of fever (80%), pain (60%) and skin discoloration (60%). Among the practitioners who experienced Fournier's gangrene, none of them provided antibiotics prior to the procedure. However, these practitioners performed twice as many annual vasectomies than the non-Fournier's gangrene practitioner pool, 1160 versus 577, respectively. Among those with Fournier's gangrene post-vasectomy, all of them were managed with antibiotics and surgical debridement of which 60% (3) did not require ICU stay, 60%(3) had either temporary or permanent disability with only 20%(1) with complete resolution. Conclusions Globally, multiple specialties perform vasectomies. Fournier's gangrene is a rare yet debilitating complication that can result uncommonly after a vasectomy. The likelihood of encountering a Fournier's gangrene complication is positively associated with the number of vasectomies performed by a practitioner. Disclosure No

Medial thigh fasciocutaneous flaps for reconstruction of the scrotum following Fournier gangrene: A case report

Fournier's gangrene, a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that leads to extensive soft tissue necrosis, remains a medical‐surgical emergency. The authors present a case of coverage of a scrotal loss of substance with testicular exposure by a medial fasciocutaneous flap of the unilateral thigh after debridement and initial medical treatment of Fournier's gangrene in a 50‐year‐old quadriplegic patient. The clinical examination at 8 months showed an aesthetic and functional result. The trophic‐cutaneous thigh flap that the authors propose for frail, elderly, and neurological subjects with low functional requirements allows coverage of the scrotal region with relatively thick skin, color, and texture close to those of the scrotum. It also offers technical simplicity, moderate scarring, and functional remnants at the price of less morbidity.

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.

A Case Report of Fournier's Gangrene.

Fournier's gangrene, necrotizing soft tissue infection, necrotizing fasciitis.

Candida Parapsilosis As A Cause Of Necrotizing Fasciitis (Fournier’s Gangrene): A Concern For Patient Safety In Low Resource Settings

Fournier's gangrene (FG) is a polymicrobial aerobic and anaerobic bacterial infection with a rare occurrence of primary fungal aetiology. Here we report a case of FG caused by Candida parapsilosis as the primary organism in a 29-year-old man who presented with perineal soft-tissue infection. He had surgical debridement and colostomy for fecal diversion. He was treated with both antifungal and antibacterial drugs. This case highlights the need to consider fungal pathogens as primary aetiologic agents of FG. This further buttresses the need for antimicrobial stewardship with emphasis on targeted therapy to ensure patient safety.

Fournier's gangrene in an eight-day-old male neonate, a case report

Introduction and importanceFournier's gangrene is necrotizing fasciitis of the scrotum and perineal area. It is a polymicrobial infection of perianal origin characterized by rapid necrotizing spread along fascial planes to abdominal wall and flank area. The very rare nature of this illness in neonates makes it important to take a lesson in subsequent management of similar cases.Case presentationAn eight days old male neonate come with compliant of high-grade intermittent fever, scrotal swelling, crying during urination and irritability of 3 days duration. Objectively he has temperature of 38.8 degree Celsius, pulse rate of 172 and blackish ulcerated scrotum with minimal puss discharge. Blood work showed leukocytosis and scrotal ultrasound ruled out other pathology.Clinical discussionIdentifiable causes constitute about 80% of the cases. Culture from the puss in our case showed polymicrobial cause. Mortality is mainly due severe sepsis, coagulopathy and renal failure. Medical management include optimization of cardiorespiratory status with cautious resuscitation, respiratory support and inotropic support with severe cases. Prompt surgical debridement, incision and drainage help reduce ongoing infection and systemic toxicity.ConclusionThe poor hygiene and immature immune response are the likely predisposing factors. Medical management with broad spectrum antibiotics and surgical debridement are cornerstones for good recovery.

Practical Review of the Current Management of Fournier's Gangrene.

Background:Fournier’s gangrene is a fulminant disease. If diagnosed and treated early, mortality can be minimized, but morbidity can still be important with extensive soft tissue defects affecting form and function. We aimed to perform a comprehensive review and provide the current evidenced-based management to treat this condition.Methods:A review was conducted to identify relevant published articles involving Fournier’s gangrene in PubMed on September 8, 2021. Search keywords included “{[(Fournier’s gangrene) AND (reconstruction)] OR [Fournier’s gangrene]} AND [(repair) OR (management)].”Results:A total of 108 articles met the inclusion criteria. The comorbidities most frequently associated included diabetes, hypertension, and obesity. Pillars of treatment involve urgent debridement, fluid resuscitation, IV antibiotics, and reconstruction. Several variables must be considered, including time to debridement, duration of antibiotics, debridement, and an individualized approach to choose a reconstructive option. Skin grafts and multiple types of flaps are commonly used for reconstruction.Conclusions:Treatment of Fournier’s gangrene should be initiated as early as possible. Surgeons’ expertise, patient preference, and resources available are essential factors that should direct the election of reconstruction.

Coverage of External Genitalia and Perineal Defects after the Fournier’s Gangrene

Introduction: We report the experience of the National Center of Burns and Plastic Surgery of Ibn Rochd University Hospital of Casablanca in the coverage of defects secondary to Fournier’s gangrene. Materials and Methods: We retrospectively collected and analyzed clinical, therapeutic, and scalable data of patients referred for perineal coverage after Fournier's gangrene, during a period of 3 years (from January 2018 to December 2020), including age, gender, medical background, Charlson comorbidities index; cause, period of coverage, Performance Status score, the extent of the defect and affected sites, Anesthesia, Surgical technique, and post-operative suites. Results: 46 patients were identified: 43 males (93%) and 3 females (7%); mean age was 53 years. Diabetes was the most common comorbidity (58%). The major cause was proctologic (60.9%). The average consultation time was 44.15 days. The patients presented with defects measuring between 4 cm2 and 800 cm2, mostly affecting the scrotum (80%). Several surgical techniques have been employed and added together, depending on the extent and topography of the defect. 20 were treated by suturing due to sufficient skin laxity, 13 were covered by skin grafting of the penis and/or for an extensive and/or oozing defect. 20 were covered by a scrotal advancement flap for a defect not exceeding half of the scrotum. The fascio-cutaneous flaps, namely the VY advancement flap was performed in 14 patients (uni or bilateral), and the medial thigh flap which was performed in 3 patients, for defects involving the perineum and/or more than half of the scrotum. Seven patients (15.21%) presented coverage technique complications. Conclusion: Adequate coverage of the perineum and external genitalia after the Fournier's gangrene prevents functional sequelae and reduces aesthetic sequelae.

SGLT-2 inhibitors increase risk of Fournier's gangrene, especially in male patients

SGLT-2 inhibitors increase risk of Fournier's gangrene, especially in male patients

Acute necrotizing pancreatitis complicating as Fournier’s gangrene

Scrotal involvement is extremely rare complication of acute necrotising pancreatitis. It presents as scrotal swelling and skin color change, which mimics the presentations of testicular torsion, epididymitis, and testicular tumor. Early diagnosis can significantly reduce the associated mortality both with necrotising pancreatitis and Fournier gangrene. Thorough clinical examination along with abdominopelvic Computed Tomography provides a useful means of diagnosing this complication. Here, we are presenting a case of acute necrotising pancreatitis with collection in left pararenal space tracking all the way to reach the left inguinal canal till the root of scrotum, being managed successfully after early diagnosis with early debridement and application of vacuum assisted drainage.

Fournier's Gangrene, Urological Emergency

Fournier's gangrene is a serious infection of the genital and perineal area, potentially fatal with a higher prevalence in males; It is considered a urological emergency, for which an opportune diagnosis is the norm. Patients present with systemic symptoms, genital discomfort, intense and penetrating pain in the perineoscrotal region. The prognosis is usually ominous, in most cases it is influenced by factors specific to the immunocompromised host, as well as by factors. The mortality rate is estimated to be 88%. A high index of diagnostic suspicion is essential, based on the accelerated progression of symptoms of an infectious process in the genital region, such as blisters, necrosis, and fetid lesions. The diagnosis of the disease focuses on laboratory and imaging studies. The basis of treatment is surgical intervention, in the same way the administration of antibiotics is recommended as soon as possible. Patients with a timely diagnosis who underwent debridement have a lower risk of mortality.

Fournier's Gangrene, Urological Emergency

Fournier's Gangrene, Urological Emergency

Outcomes of Patients with Necrotizing Soft Tissue Infections: A Propensity-Matched Analysis Using the National Inpatient Sample.

Background: Necrotizing soft tissue infections (NSTIs) are severe, rapidly spreading infections with high morbidity and mortality. Attempts to identify risk factors for mortality and morbidity have produced variable results. We hope to determine which factors across the NSTI population impact mortality, morbidities, and discharge disposition. Patients and Methods: Retrospective data from the National Inpatient Sample from 2012-2018 of patients with primary diagnosis of NSTI (gas gangrene, necrotizing faciitis, cutaneous gangrene, or Fournier gangrene) were identified for analysis. A 1:4 greedy match was performed and risk factors for in-hospital mortality and discharge disposition were examined. Continuous variables were assessed using t-tests and Wilcoxon rank sum tests. Categorical variables were assessed using χ2 and Fisher exact tests. Statistical significance was defined as p < 0.05. Results: A total of 6,608 patients were identified. Weighted, this represents 33,040 patients; 32,390 are in the no-mortality cohort and 650 in the mortality cohort. Advanced age group was a risk factor for both in-hospital mortality and morbidity, but not for discharge to a skilled nursing or rehabilitation facility. Having two or more comorbidities was a risk factor for mortality, morbidity, and discharge to skilled nursing or rehabilitation facility. Cancer, liver disease, and kidney disease were predictors of in-hospital mortality. Diabetes mellitus and kidney disease were predictors of experiencing an in-hospital complication. Diabetes mellitus, heart disease, and kidney disease were predictors for discharge to skilled nursing or rehabilitation facility. Conclusions: Necrotizing soft tissue infections are associated with substantial morbidity and mortality. Identifying patients at higher risk for mortality, morbidity, and higher level of care at discharge can help providers properly allocate resources to improve patient outcomes and reduce the financial burden on patients and healthcare facilities. Special attention should be paid to those with existing or acute kidney dysfunction because this was the only comorbidity associated with increased risk mortality, morbidity, and discharge to higher level of care.

A patient with Type 2 Diabetes Mellitus (T2DM) with Fournier gangrene: a case report

Background: Fournier gangrene is necrotizing fasciitis of the genitalia and perineum that can extend to the abdominal wall, gluteus or lower extremities. Predisposing factors for Fournier gangrene include obesity, diabetes mellitus (DM), alcoholism, smoking, hypertension, chronic kidney disease, perianal trauma and immunosuppressive conditions. This case report aims to evaluate the management of Fournier gangrene on metabolic and surgical treatmentCase Presentation: A-53 years old-female with Type 2 Diabetes Mellitus (T2DM) came to the Emergency Ward of Dr. Sutomo General Hospital, Surabaya, with the chief complaint of sores on the buttocks for 1 week. The patient was diagnosed with Fournier gangrene. On physical examination in the room, erythematous macular lesions were found in the folds of the breast and armpit on chest examination. Obtained scratch marks were found because the patient is often scratched. The wound from the buttock and keep enlarged due to the Fournier gangrene ( necrotizing infection). In this case, the patient was given the antibiotics ceftriaxone and metronidazole. The patient died during the 8th day of treatment due to a suspected septic shock.Conclusion: Surgical management in this patient is debridement. Multi-disciplinary management of obstetrics, urology, digestive surgery, and plastic surgery is required for the management of Fournier gangrene in T2DM patients

Effectiveness and safety of dapagliflozin in real-life patients: data from the DAPA-RWE Spanish multicentre study.

BackgroundThis study aims to evaluate dapagliflozin in patients with type 2 diabetes (T2D) in clinical practice in Spain.MethodsThis is a retrospective study including adults with T2D under stable antidiabetic therapy, with either dapagliflozin or sitagliptin ≥6 months, before inclusion. Data about the effectiveness and safety of dapagliflozin are presented.ResultsA total of 594 patients (61.8±9.9 years, 21.7% cardiovascular disease) were included. After 6 months, HbA1c, weight, blood pressure, urine albumin-to-creatinine ratio and uric acid significantly decreased (1.63%, 2.88 kg, 4.82/2.70 mmHg, −17.38 mg/g and −0.30 mg/dL, respectively), whereas glomerular filtration rate and haematocrit significantly increased (3.72 mL/min/1.73 m2 and 1.8%, respectively). No cases of hypoglycaemia, diabetic ketoacidosis, Fournier gangrene, fractures or amputations were reported.ConclusionThus, dapagliflozin provides a comprehensive cardiometabolic protection in patients with T2D.

The role of C-reactive protein ratio in predicting mortality in patients with Fournier gangrene.

This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG). Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses. The mean CRP ratios were 6.7±6.6 in the survivor group and 1.2±0.8 in the nonsurvivor group (P=0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5±2.5 vs. 3.5±2.2, P=0.001). There was a negative correlation between FGSI and CRP ratio (r=-0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; area under the ROC curve, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤1.78 increased 26.7 fold for those with CRP ratio of >1.78 (95% confidence interval [CI], 4.8-146.5; P=0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5-72.2; P=0.019) and FGSI (OR, 17.8; 95% CI, 2.6-121.1; P=0.003) were independent risk factors for death. The CRP ratio is a simple method to use to predict mortality in FG.

Multimodal management of Fournier’s gangrene with subsequent wound closure techniques

Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompromised, first described in 1883 by the French dermatologist Jean Alfred Fournier. It is a form of necrotizing fasciitis of the perineal, genitourinary and perianal regions mostly in males with a mortality of nearly 20-50%. It is a surgical emergency and requires early diagnosis aided by scores such as laboratory risk indicator for necrotising fasciitis (LRINEC) and FG severity index (FGSI), extensive debridement combined with supportive procedures to manage associated complications and broad-spectrum antibiotics. Management of FG thus required a multimodal approach and emphasis on reconstruction after recovery in patients who survive was crucial to improving the quality of life in these patients. Here we were presenting 7 cases of FG successfully managed at our institution, grouped under the four methods by which wound closure was achieved: fecal diversion and split skin grafting of scrotum, urinary diversion and penoscrotal split skin grafting, delayed primary closure (with and without orchidectomy) and wound healing by secondary intention.