Abstract

In this study we aimed to evaluate the etiologic factors and the effects of surgical debridement, wound management and adjunctive therapies on mortality and morbidity of Fournier’s gangrene. 25 male, one female, a total of 26 patients treated for Fournier’s gangrene between January 1990-December 2000 were evaluated retrospectively. The mean age of our patients was 57. The etiologic origin of the gangrene was urogenital region in 12, skin in 6, anorectal region in 3 and unknown in 5 patients. Predisposing factors were diabetes in 11, alcohol and drug abuse in 2, paraplegia in one and renal insufficiency in one of the patients. The pathology began in scrotum in 19, in perineum in 5, in penis after self-cavernous injection in one and in vulva in one of the patients. Mean duration of time from the establishment of symptoms to hospital admission was 4.7 days. The pathology was limited to genitalia in 9, extending to perineum in 7, umbilicus in 7 and the axillary region in 3 patients. A repeat debridement was not necessary in 15 patients whereas a second debridement in 9 and a third in 2 were done. Mean hospitalization time was 19 days. A cystostomy in 17 patients and a colostomy in two were necessary. We applied hyperbaric oxygen therapy in 2 and honey in 5 patients to accelerate wound healing. Plastic surgery and grafting were necessary in 13 patients. Our mortality was 8%. Early recognition of the pathology and aggressive surgical debridement of the necrotic tissues can improve survival in patients with Fournier’s gangrene. Initiation of broad-spectrum antibiotics, haemodynamic and nutritional support and a multidisciplinary approach are also important in the management. Repeat operative debridement should always be done when necessary and adjunctive therapies like hyperbaric oxygen therapy may be used in severe cases.