Gangrene Severity Index Score Research Articles

Outcome of Fournier's gangrene in relation to Fournier Gangrene Severity Index (FGSI) score.

Fournier's gangrene is a rapidly progressive necrotizing fasciitis, involving perineum mainly. The purpose of the study is to evaluate etiology, treatment, and outcome of Fournier's gangrene so that such type patient's management can be done by primary care physicians with best outcomes. This was a retrospective study including 156 patients, treated for Fournier's gangrene, between Jan 2012 and Dec 2018. The outcome and prognosis of Fournier's gangrene were reviewed. The mean age and mode among survival patients were 47.94 ± 14.9 and 60 years, and the mean age and mode in nonsurvival patients was 47.64 ± 15.9 and 65 years. The most common predisposing factor was diabetes mellitus (n = 49, 31.4%) having mortality rate was 9% (n = 14). Most common causative bacteria were E. coli. In the study, the survival rate was 100% in patients having Fournier Gangrene Severity Index (FGSI)≤3. As FGSI increased from 3, the mortality rate increased. Fournier gangrene is a surgical emergency. Early diagnosis, serial surgical debridement, and broad-spectrum antibiotics decrease the mortality and morbidity of patients. The sensitivity and specificity of FGSI determine the prognosis of Fournier's gangrene. FGSI is a simple method to know the severity and prognosis.

Clinical features and treatment outcomes of Fournier's gangrene in a single tertiary emergency hospital: Simplified Fournier's Gangrene Severity Index score is a predictor for death.

To assess the predictive reliability of the Simplified Fournier's Gangrene Severity Index Score (SFGSI) for mortality in Japanese patients with Fournier's gangrene (FG), we compared the clinical features and outcomes of a patient sample with the SFGSI. The medical records of 36 patients diagnosed with FG at our hospital between October 2007 and September 2022 were reviewed retrospectively. Clinical and laboratory variables, including SFGSI, were evaluated and predictive factors for fatality were investigated using multivariate logistic regression analysis. The median age and body mass index were 65 and 24.2, respectively. Eight patients had cooccurring chronic kidney disease and 23 had diabetes. None were taking sodium-glucose co-transporter-2 (SGLT-2) inhibitors. The causative organisms were diverse, and no specific trends in causative organisms were observed. 26 patients underwent debridement of necrotic tissue including eight colostomies, two orchiectomies, and one cystectomy. Multivariate logistic regression analysis revealed that SFGSI alone was an independent predictor of case fatality, with an odds ratio of 20.167 (95% CI: 1.66-245.53). In conclusion, the fatality rate was 19.4%, which was comparable to that reported in other studies. The SFGSI was an independent predictor of mortality in this study.

Evaluation of Negative Pressure Wound Therapy in the Management of Fournier's Gangrene.

Introduction Necrotizing soft tissue infections (NSTIs), including Fournier's gangrene (FG), are severe polymicrobial bacterial infections characterized by rapidly spreading inflammation and tissue necrosis. This study aims to compare the clinical outcomes of vacuum-assisted closure (VAC) dressing and conventional dressing in patients with FG. Materials and methods A prospective study was conducted from December 2020 to May 2022, including patients with clinical features suggestive of FG. Patients were divided into two groups: conventional dressing and VAC dressing. Relevant clinical data, including age, duration of hospital stay, wound status, Fournier's gangrene severity index (FGSI) scores, sepsis markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, and procalcitonin), and pain assessment, were recorded and compared between the two groups. Results A total of 84 patients were included in the study, with 42 patients in each group. The mean age was 57.48 ± 15.74 years in the conventional dressing group and 50.83 ± 13.95 years in the VAC dressing group. VAC dressing was associated with a significantly shorter duration of hospital stay (8.14 ± 3.13 days) compared to conventional dressing (11.36 ± 4.75 days). The average time taken for wound closure was significantly reduced in the VAC dressing group (63 ± 14.81 days) compared to the conventional dressing group (112.56 ± 13.82 days). FGSI scores showed significant improvement after debridement in both groups, with lower scores in the VAC dressing group at discharge. Sepsis markers such as CRP and serum procalcitonin exhibited a significant decrease after VAC application. Discussion The study demonstrates that VAC therapy is associated with better clinical outcomes in FG, including reduced duration of hospital stay, faster wound closure, improved FGSI scores, decreased sepsis markers, and reduced pain. These findings align with previous studies highlighting the advantages of VAC therapy over conventional dressing methods. Conclusion VAC therapy provides significant benefits in the management of FG, leading to improved clinical outcomes and patient quality of life. It offers advantages such as shorter hospital stays, faster wound closure, and reduced sepsis markers. The application of VAC dressing should be considered a valuable treatment modality for FG.

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.

Outcome management of Fournier's gangrene cases at tertiary hospital: 7 Years experience.

This study aims to describe the condition of Fournier's gangrene in Dr. Soetomo General Hospital from January 2014 to December 2020. This study used a retrospective analytic design, by taking data through medical records at Dr. Soetomo General Hospital from January 2014 to December 2020. This study used total sampling with recorded data: age, gender, length of stay, outcome, location, comorbidities, causes, management, culture results, and Fournier's gangrene severity index (FGSI) score. Of the 135 subjects collected, it was found that 55.56% were individuals over 50 years of age. About 91.11% were male patients, with some sites being in the scrotum 50.37%. Only 25.19% of patients had no comorbids, while the rest had a history of CKD, hypertension, diabetes, or a combination of these diseases. Bacterial cultures obtained were mostly caused by the Enterobacteriaceae bacteria group (32.59%). Of the subjects we studied who experienced mortality, it was found that all were from the group with FGSI >9. From the results of our descriptive study, at a glance, it appears that there is a tendency for the incidence of Fournier's gangrene in the elderly and individuals with comorbidities. And the mortality rate increases with a high FGSI value. So that FGSI could be used as a predictor of mortality in patients with FG.

MICROBIOLOGICAL PROFILE, ANTIBIOTIC SENSITIVITY AND PROGNOSIS OF PATIENTS WITH FOURNIER’S GANGRENE: A PROSPECTIVE, HOSPITAL BASED STUDY FROM NORTH INDIA

Background: Fournier's gangrene (FG) is a devastating disease that is characterized by necrotizing fasciitis of the perineal, genital, or perianal region. Broad-spectrum antibiotics are the key component of its treatment. However, there is paucity of data regarding the optimal empirical antibiotic therapy for FG. Materials and Methods: Data from patients who underwent surgery for FG was retrieved from a prospectively collected departmental FG database. Demographics, clinical characteristics, causative pathogens and drug susceptibility/resistance were evaluated. Outcome was also assessed in terms of mortality. Results: Fifty patients with a median age of 58.5 (40-83) years were included. The perianal region and scrotum (88%) were the most commonly affected. Diabetes mellitus (DM) was the most common comorbidity (92%). The median time to onset of symptoms was 7 (2-15) days, and the median duration of hospital stay was 22 (4-65) days. Ventilator requirement was required in 15 (30%) patients. The median UFGSI score was 9.5 (3-15). The overall mortality rate was 26%. A positive growth was found in specimen cultures of 48 (96%) patients. The median number of bacterial strains that grew in the cultures was 3 (0-10). Amikacin was the antibiotic with the highest frequency of sensitivity (74%), while the highest resistance was observed against ampicillin-sulbactam (64%). Escherichia coli was the most common microorganism (68%). Acinetobacter baumannii and Klebsiella pneumonia were signicantly more common in patients who required mechanical ventilation. The mortality rate was 26%. An Uludag Fournier's Gangrene Severity Index (UFGSI) score of > 9.5 and ventilatory support requirement were factors associated with an increased rate of mortality. Acinetobacter baumannii was the only microorganism which was associated with an increased mortality rate. Conclusion: Causative pathogens in FG appeared to be shifting; thus, empirical antibiotic treatment for this disease should be modied. We recommend 3rd-generation cephalosporin, metronidazole and amikacin for empirical therapy.

Can we predict poor prognosis in Fournier gangrene?

Aim: Fournier’s gangrene (FG) is a rapidly progressing and highly mortal necrotizing fasciitis that develops due to polymicrobial infection of the genital, perineal and perianal regions. Advanced age, comorbidities, width of the infected area, leukocyte-lymphocyte ratio, number of debridement performed, and Fournier’s gangrene severity index (FGSI) score are reported as prognostic factors for FG. In our study, we aimed to present the clinical and laboratory findings that can be used to predict poor prognosis in Fournier gangrene. Methods: In this retrospective cohort study, the files of 83 patients treated for FG were retrospectively analyzed. Demographic data, laboratory findings, treatments, age adjusted Charlson comorbidity index (ACCI), FGSI score, LRINEC score, complications and mortality were noted. Risk factors affecting mortality were determined. Results: Male/female ratio was 7.3. The mean age of the patients were 55.4 years. The mortality rate was 21.7%. The mean ACCI scores (Mortality group: 6.00 (2.72), survivors’ group: 2.66 (2.39)) and FGSI scores (Mortality group; 11.22 (3.2), survivors’ group; 3.25 (2.08)) of non-surviving patients were higher than those of survivors (P<0.001, P<0.001, respectively). Also, the mean neutrophil-lymphocyte ratio (Mortality group: 21.05 (15.67), survivors’ group: 11.62 (10.50), (P=0.013), and the mean LRINEC score (Mortality group: 7.17 (2.03), survivors’ group: 3.18 (2.59)) (P=0.001) were higher among non-survivors. Cut off values for FGSI score, LRINEC, ACCI, and neutrophil / lymphocyte ratio were 7.5 (94.4% sensitivity and 95.4% specificity), 4.5 (94.4% sensitivity and 67.7% specificity), 3.5 (77.8% sensitivity and 73.8% specificity), and 8.70 (72.2% sensitivity and 52.3% specificity), respectively, in predicting mortality. Mortality was higher in female patients compared to males (P=0.02), and among the diabetics (P=0.05). Conclusion: We think that risk factors such as advanced age, diabetes, female gender, high ACCI score, high FGSI scores, high LRINEC scores and high neutrophil lymphocyte ratio are predictive of poor prognosis in FG.

Factors affecting length of stay in Fournier's gangrene: a retrospective analysis of 10 years' data.

We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier's gangrene. A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier's gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier's Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated. Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ± 2.5 days. As a result of the statistical analyses, it was found that Fournier's Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier's Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality. Fournier's gangrene is a mortal disease and an emergency condition. With the improvements in Fournier's gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice.

Comparison of Mortality in Fournier's Gangrene with the Two Scoring Systems.

To determine the factors associated with mortality in Fournier's gangrene (FG) toward informing the development of effective treatment strategies. A descriptive study. Department of Surgery, University of Health Sciences, Okmeydani Education and Research Hospital, Istanbul, Turkey, from February 2012 to September 2017. Informations of 30 patients treated for FG were examined retrospectively. The deceased patients (Group 1, n = 8) were analysed separately from the living ones (Group 2, n = 22). Informations in this analysis contained gender, age score, dissemination score, Uludag Fournier's Gangrene Severity Index (UFGSI) and Fournier's Gangrene Severity Index (FGSI) scores, serum levels of urea, infection source, the presence of diabetes, obesity, and other comorbidities, the presence of stoma for diversion, duration of the vacuum-assisted closure treatment, hospitalisation time, intensive care period, and species of bacteria isolated. The overall mortality rate was detected as 26%. A significant difference between the two groups concerning age score of UFGSI parameters was found. The dissemination score of the infection, which is one of the UFGSI parameters, was significantly higher in Group 1 than in Group 2. According to UFGSI and FGSI scores, the scores of group 1 patients were significantly higher. To determine the incidence of mortality, the UFGSI and FGSI had 87.5% sensitivity and had 96% and 91% specificity, respectively. The cut-off values for UFGSI and FGSI were 10 and seven, respectively. Based on the findings described in this study, age and dissemination scores from the UFGSI can be used to predict patient outcome. Patients with a UFGSI score greater than 10 have a higher mortality rate.

Emergency management and it’s effect on clinical profile of Fournier’s gangrene in patients presenting at a rural setup

Background: Fournier’s gangrene (FG) is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. This study describes our experiences in the management of FG and identifies prognostic factors.Methods: It is a descriptive prospective study in 71 patients with FG treated at Pravara Rural Medical College and Hospital, Loni, who presented between September 2013 and September 2015.Results: In the present series of 71 patients, 57% were between 50-70 yrs. UTI and alcohol consumption being most common co-morbid conditions and scrotal abscess (53.52%) being the most common presentation. Serum creatinine (p value 0.0008), total leucocyte count at presentation (p value 0.004) had a significant association with duration of recovery. The mean duration of stay was 16.08±3.28 days with a median of 15 days. The Fournier gangrene severity index score calculated was &lt;9 in 59.15% of patients, and &gt;9 in the remaining ≈40% with a mean of 8.309±3.49. A single mortality was recorded during our study.Conclusions: Serum creatinine and total leucocyte count at presentation could play a pivotal role in not only initial emergency management but also as factors for monitoring the progress of treatment.

Fournier's gangrene: a modern analysis of predictors of outcomes.

Fournier's gangrene (FG) is a rapidly progressing necrotizing fasciitis that carries a significant morbidity and mortality. The present study sought to identify the predisposing factors related to FG and validate the Fournier's Gangrene Severity Index (FGSI) score as a prognostic tool in the care of the Fournier's patient. Medstar Washington Hospital Center records were searched from January 2003 to February 2015 for all patients with a diagnosis code of FG, n=42. Epidemiologic data was collected for patients and used to calculate an FGSI score. The average age was 53.45 yrs and M/F ratio was 39:1. Patients presented with an average 2.675 predisposing factors; the most common was diabetes mellitus (n=21) followed by hypertension (n=18). The most common etiology was periscrotal (n=25) next to perirectal (n=9). Streptococcus was the most common source of infection (n=14). Patients on average required three surgical interventions. The average and median hospitalization period was 19.625 and 11.5 days respectively. Eleven patients developed sepsis. Twenty-four (60%) patients experienced a complication. The overall mortality was 5% (n=2). The average FGSI on admission was 5.368. Multivariate analysis showed FGSI score correlates with more surgical intervention, longer hospitalization, sepsis, complication and mortality. The FGSI score predicts a greater likelihood of more surgical interventions, longer hospitalization period, sepsis, complications and mortality within this patient population. Diabetes mellitus continues to be the most common predisposing factors in FG patients. The mortality rate of 5% is much less than the historically reported 20-30% and may reflect improved understanding and care of this aggressive disease.

Factors Affecting Mortality in Fournier Gangrene: A Single Center Experience.

The objective of this study was to determine the clinical and laboratory features affecting mortality in Fournier gangrene. This retrospective case control study was designed to evaluate patients treated for Fournier gangrene in our center between 2010 and 2018. Those patients were divided into two groups: discharged patients (group 1) and deceased patients (group 2). Comparisons were made regarding clinical and demographic features; leukocyte, neutrophil and lymphocyte count results; neutrophil to lymphocyte ratio (NLR); Fournier's Gangrene Severity Index (FGSI) scores; number of debridements; complications; and mortality rates. Twenty-three patients (19 males, 4 females) were evaluated; mean age was 65.91 ± 16.34 years. The most common cause of the disease and comorbidity were perianal abscess (n = 14; 60.9%) and type 1 diabetes mellitus (n = 11; 47.8%), respectively. Escherichia coli was the pathogen identified most often (n = 17; 73.9%). The total mortality rate was 21.7% (n = 5). Neutrophil to lymphocyte ratio, FGSI, number of debridements, and complication rates were higher in group 2 (p < 0.05). There was a substantial difference between the groups regarding perianal abscess in group 1 and rectum cancer in group 2 (p < 0.05). In conclusion, it was believed that the mortality rate could be predicted by combining the NLR value with the FGSI score.

Suture Technique to Prevent Air Leakage during Negative-Pressure Wound Therapy in Fournier Gangrene.

Background:The use of negative-pressure wound therapy (NPWT) for Fournier gangrene management is well documented; however, it is difficult to fixate GranuFoam dressings and maintain an airtight seal over the perineum area. We developed a simple method to facilitate GranuFoam fixation and improve airtight sealing.Methods:The Fournier’s gangrene severity index (FGSI) score less than 9 was collected in from January 2015 to October 2016. All 13 patients underwent fasciotomy, and NPWT was applied directly on fasciotomy wounds after the debridement of infected tissue. Partial wound closure was performed, and a portion of GranuFoam was inserted to facilitate fixation. The seal check was converted to a 0–10 scale score that was recorded every 4 hours during NPWT. Patient profiles including medical history, FGSI, method of wound closure, and length of stay were collected in this study.Results:The median age of the patients was 62 (38–76) years. The mean FGSI score was 4.3 ± 3.1. The average duration of NPWT was 17.5 ± 11.5 days, and the average seal check score was 0.8 ± 0.5. No seal check alarms were noted during the study. Successful wound closure was achieved in all patients without using additional reconstruction methods such as skin grafting or muscle flap coverage.Conclusions:The present results suggest that partial wound-edge closure and in situ GranuFoam fixation improve the NPWT leaks in Fournier gangrene wounds. Furthermore, this method is simple to learn and can be useful in applying NPWT to anatomically difficult areas.

Prognostic factors and treatment outcomes for patients with Fournier's gangrene: a retrospective study.

Fournier's gangrene is a gas-forming, necrotising soft tissue infection affecting the perineum. It spreads rapidly along the deep fascial planes and is associated with a high mortality rate. With a growing elderly population with comorbidities, the frequency of severe cases of Fournier's gangrene is expected to increase. We retrospectively reviewed 20 patients diagnosed with Fournier's gangrene at our institution from 2003 to 2014 and analysed data. Thirteen patients had diabetes mellitus, two had been diagnosed with liver cirrhosis, and four were chronic alcoholics. Of 15 patients admitted to an intensive care unit, 11 underwent colostomy, and 4 required skin grafts for wound healing. The wide wounds of two patients were healed using vacuum-assisted closure (VAC® ) dressing without additional surgery. The mortality rate was 25%, and the patients whose Fournier's gangrene severity index (FGSI) score was higher than 9 points or whose blood urea nitrogen (BUN) level was higher than 50 mg/dl had a poor prognosis. In order to treat Fournier's gangrene, aggressive surgical treatment, including wide debridement and stoma creation, should be considered as soon as possible to improve survival rates. Additionally, VAC dressing is helpful in healing the wide debridement wound without additional reconstructive surgery.

Fournier's Gangrene: A Review and Outcome Comparison from 2009 to 2016.

Objective: The outcome of Fournier's gangrene (FG) may be affected by comorbidities, demographics, and choice of treatment modality. We sought to evaluate our institution's management protocol of FG measured by mortality rate (MR) and length of hospital stay (LHS) in a retrospective cohort study. Approach: A database of 20 FG cases at our institution throughout the 2009-2016 study period was assembled by a retrospective review of medical records. A Fournier's Gangrene Severity Index Score (FGSIS) was calculated for each case. Data were analyzed for statistical significance using logistic regression. Results: The most common presentation of FG at our institution was a hyperglycemic diabetic male in his fifth decade of life with a second risk factor such as recent surgery or active malignancy. The average FGSIS was 9 overall and 14 for the mortalities. An increased FGSIS was predictive of having an increased MR or hospital stay above the median (>25 days) (p = 0.0194). The average LHS was 32 days overall, 22 days for patients treated with hyperbaric oxygen therapy and 40 days for patients treated with tangential hydrosurgery. Overall MR was 15%. Innovation: This is the second known study to characterize usage of tangential hydrosurgery in the management of FG. Conclusion: Treatment outcomes at our institution are comparable to those reported in recent literature, a significant decline from the historical MR of 50-60%.

Microbiological aspects of Fournier's gangrene

BackgroundFournier's gangrene (FG) is a devastating disease that is characterized by necrotizing fasciitis of the perineal, genital, or perianal region. Broad-spectrum antibiotics are the key component of its treatment. However, there is paucity of data regarding the optimal empirical antibiotherapy for FG. Materials and methodsData from patients who underwent surgery for FG between January 2007 and December 2012 were retrieved from a prospectively collected departmental FG database. Demographics, clinical characteristics, causative pathogens and drug susceptibility/resistance were evaluated. ResultsFifty patients with a median age of 58.5 (22–83) years were included. The perianal origin (58%) was most commonly affected. A positive growth was found in specimen cultures of 48 (96%) patients. The median number of bacterial strains that grew in the cultures was 3 (0–10). Amikacin was the antibiotic with the highest frequency of sensitivity (74%), while the highest resistance was observed against ampicillin-sulbactam (64%). Escherichia coli was the most common microorganism (72%). Acinetobacter baumannii and Klebsiella pneumonia were significantly more common in patients who required mechanical ventilation. The mortality rate was 26%. An Uludag Fournier's Gangrene Severity Index (UFGSI) score of >9.5 and ventilatory support requirement were factors associated with an increased rate of mortality. Acinetobacter baumannii was the only microorganism which was associated with an increased mortality rate. ConclusionCausative pathogens in FG appeared to be shifting; thus, empirical antibiotic treatment for this disease should be modified. We recommend 3rd-generation cephalosporin, metronidazole and amikacin for empirical therapy.

The socio-demografic characteristics of enuresis nocturna in childhood

Background: Fournier’s gangrene (FG) is a rapidly progressive, destructive, necrotizing fasciitis of the perianal, perineal, and genital regions. Common clinical symptoms include sudden intense pain in the scrotum, prostration, fever, and pallor. In this study, the aim was to assess FG through a wider lens. Methods: 60 patients that presented with FG at the authors’ hospital over a 6-year period between April 2008 and March 2014 were retrospectively reviewed. Age, gender, site of gangrene, risk factors, symptoms, microbiology, treatment modalities, Fournier’s Gangrene Severity Index score (FGSI), and mortality data were evaluated. Results: 60 male patients with a mean age of 55 (ranging between 48-62) were included in the study. 50 patients survived and the mortality rate was 16.6%. Septic shock (n: 4), cardiogenic shock (n:4), and pneumonia (n:2) were the official causes of death. As a risk factor, 45 (75%) patients had diabetes mellitus (DM), 40 (66.6%) had hypertension (HT), and 35 (58.3%) had both DM and HT. There were no other co-morbidities in the 10 (16.6%) remaining patients. All the surviving 50 patients were suitable for surgical reconstruction. A split thickness skin grafting procedure was performed for 46 (76.6%) patients and flap reconstruction was performed for 4 (6.6%). None of the patients had hyperbaric oxygen therapy (HBO). The mean length of hospitalization was 16 days (ranging from 5-58) for all patients. A mean FGSI score at admission was 5.02 ± 2.45 for survivors compared with 13.8 ± 4.53 for non-survivors. A mean FGSI score was 4.56 ± 2.28 for survivors and 11.50 ± 2.63 for non-survivors during hospitalization. Conclusion: Although FG has a high mortality rate, appropriate management of the disease can reduce it. Early diagnosis, surgical debridement, vacuum-assisted closure application, and antibiotherapy are essentials for treating FG.

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.

Predictive Factors for Mortality in Fournier's Gangrene: A Series of 59 Cases

AimsFournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area and presents a high mortality rate. The aim was to assess prognostic factors for mortality, create a new mortality predictive scale and compare it with previously published scales in patients diagnosed with FG in our Emergency Department. MethodsRetrospective analysis study between 1998 and 2012. ResultsOf the 59 patients, 44 survived (74%) (S) and 15 died (26%) (D). Significant differences were found in peripheral vasculopathy (S 5 [11%]; D 6 [40%]; P=.023), haemoglobin (S 13; D 11; P=.014), haematocrit (S 37; D 31.4; P=.009), white blood cells (S 17,400; D 23,800; P=.023), serum urea (S 58; D 102; P=.001), creatinine (S 1.1; D 1.9; P=.032), potassium (S 3.7; D 4.4; P=.012) and alkaline phosphatase (S 92; D 133; P=.014). Predictive scores were: Charlson index (S 1; D 4; P=.013), severe sepsis criteria (S 16 [36%]; D 13 [86%]; P=.001), Fournier's Gangrene Severity Index Score (FGSIS) (S 4; D 7; P=.002) and Uludag Fournier's Gangrene Severity Index (UFGSI) (S 9; D 13; P=.004). Independent predictive factors were peripheral vasculopathy, serum potassium and severe sepsis criteria, and a model was created with an area under the ROC curve of 0.850 (0.760–0.973), higher than FGSIS (0.746 [0.601–0.981]) and UFGSI (0.760 [0.617–0.904]). ConclusionsFG showed a high mortality rate. Independent predictive factors were peripheral vasculopathy, potassium and severe sepsis criteria creating a predictive model that performed better than those previously described.

Current concepts in the management of necrotizing fasciitis.

Necrotizing fasciitis (NF) is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall, or the extremities. The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%). Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure, and liver cirrhosis. NF is classified into four types, depending on microbiological findings. Most cases are polymicrobial, classed as type I. The clinical status of the patient varies from erythema, swelling, and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection. In its fulminant form, the patient is critically ill with signs and symptoms of severe septic shock and multiple organ dysfunction. The clinical condition is the most important clue for diagnosis. However, in equivocal cases, the diagnosis and severity of the infection can be secured with laboratory-based scoring systems, such as the laboratory risk indicator for necrotizing fasciitis score or Fournier’s gangrene severity index score, especially in regard to Fournier’s gangrene. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites. Management of the infection begins with broad-spectrum antibiotics, but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. The vacuum-assisted closure system has proved to be helpful in wound management, with its combined benefits of continuous cleansing of the wound and the formation of granulation tissue.