Fournier gangrene is an acute and potentially fatal
infection of the scrotum, perineum, and abdominal wall. It is characterized by
necrotizing fasciitis with loss of subcutaneous tissue and skin. The aim of this study was to analyze the prognosis and treatment effectiveness of this fulminant
infectious disease. Forty-one patients were admitted to our hospital with the diagnosis of
Fournier gangrene between January 1998 and December 2006. The patients' age, sex, predisposing factors, duration of symptoms and
hospital stay, time to operation, size of the skin defect, bacteria isolated, treatment modalities, and outcomes were reviewed. The data were analyzed by chi2 analysis and Student t test. A P-value <0.05 was considered significant. The mean age of the patients was 57.2 years. The most common predisposing factor was
diabetes mellitus in 21 patients (51.2%), followed by
cirrhosis of the liver,
uremia,
alcoholism, and underlying
malignancy. The most common symptoms were
fever (87.8%) and
pain or swelling over the genital region (85.4%). The initial treatment included extensive
debridement and open drainage. Time to operation ranged from 1 to 10 days. Reconstructive surgery was performed for 22 patients. The mortality rate was 19.5%. Delayed
debridement was a significant factor affecting the survival rate. Our study is a retrospective study of patients with
Fournier gangrene undergoing
debridement and reconstructive procedure. Because of the fulminant course of
Fournier gangrene, it may be difficult to design a prospective study.
Fournier gangrene is a severe
infectious disease with a high mortality rate. Early and aggressive
debridement is a significant prognostic factor in the management of
Fournier gangrene. Several reconstructive modalities are useful to correct the tissue defect. Early
debridement and reconstructive surgery for
wound coverage improve the quality of life.