Fournier′s gangrene: analysis of 12 cases

Objective To summarize the clinical characteristics, therapeutic principle, and outcome of Fournier′s gangrene (FG). Methods A retrospective chart review was performed to analyze all cases of FG patients who presented at Peking University First Hospital from January 2005 to December 2016. Results Twelve patients (11 males and 1 female) were enrolled in this study. The median age was 54 years (range, 21-78 years). Etiology was confirmed in ten (83%, 10/12) patients, of whom seven suffered from perianal disease, one from abrasion to the skin on the scrotum, one from retroperitoneal abscess, and one from Bartholin′s abscess. Diabetes mellitus was the most common comorbidity associated with FG and was present in six (50%, 6/12) patients at the time of admission. One patient died of respiratory and circulatory failure on day 8 without debridement, and the rest patients were treated by repeated surgical debridement. The median number of surgical procedures was seven (range, 3-18). Negative pressure wound therapy (NPWT) was applied in seven patients, and the media number of NPWT procedures was three (range 3-7). The mean duration of wound healing was (52.7±17.7) days. There were six patients with defects that healed after split-thickness skin grafting and five with delayed primary closure. Polymicrobial infections were confirmed in six (50%, 6/12) patients, while monomicrobial infections were identified in another six (50%, 6/12). Enterobacteriaceae, Enterococcus, and Staphylococcus haemolyticus were the most common pathogenic bacteria. During the medial follow-up time of 32 months, 11 patients survived with well healed wounds. Conclusions FG is a highly fatal infectious disease. It is important to improve the understanding of FG. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score could be used for early diagnosis and differential diagnosis of FG. Aggressive debridement, empirical broad-spectrum antibiotics, and systemic supportive therapy are the key to saving life. NPWT is an effective adjuvant therapy, and free skin grafting is recommended for the reconstruction of penile and scrotal defects. Key words: Fournier′s gangrene; Necrotizing fasciitis; Negative pressure wound therapy; Debridement