Many controversial issues exist surrounding the disease pathogenesis and optimal management of
Fournier's gangrene. In Fournier's original descriptions, the disease arose in healthy subjects without an obvious cause. Most contemporary studies, however, are able to identify definite urologic or colorectal etiologies in a majority of cases. To investigate disease presentation, treatment modalities, and overall mortality, a retrospective analysis of
Fournier's gangrene from a single institution is presented. Since 1990, 26 cases of
Fournier's gangrene have been diagnosed at the University of Tennessee. An evaluation of intercurrent disease revealed that 38 percent of the patients had
diabetes mellitus, 35 percent manifested
ethanol abuse, and 12 percent were systemically immunosuppressed. Fifteen patients (58 percent) presented with identifiable etiologies for their disease: 31 percent (8)
urethral disease or
trauma, 19 percent (5) colorectal disease, and 8 percent (2)
penile prostheses. Management in all cases involved prompt surgical
debridement with initiation of broad-spectrum
antibiotics. Multiple
debridements,
orchiectomy,
urinary diversion, and fecal diversion were performed as clinically indicated. Fourteen patients received hyperbaric
oxygen as adjuvant
therapy. Statistically significant results were noted with mortality rates of 7 percent in the group receiving hyperbaric
oxygen (n = 14) versus 42 percent in the group not receiving hyperbaric
oxygen (n = 12). Overall mortality was 23 percent. Controversy still surrounds disease pathogenesis in
Fournier's gangrene, particularly in regard to etiology. Our study corroborates current trends in that a clear focus or origin was identified in a majority of the cases. Although a grim prognosis usually accompanies the diagnosis, this study shows significant improvement combining traditional surgical and
antibiotic regimens with
hyperbaric oxygen therapy.