Dermatológia pre prax 1/2015

Fournier´s gangrene

Background: Fournier´s gangrene (FG) is a rare but life – threatening disease challenging the treating medical staff. Despite the fact that antibiotic therapy combined with surgery and intensive care surveillance are performed as standard treatment, mortality rates remain high. In recent years, several authors reported an effort to create an index severity of symptoms and signs – i. e. FGSI (Fournier´s Gangrene Severity Index) score, which may have prognostic value for the affected individuals. Objective: To evaluate the current state of theoretical and practical knowledge of the FG in confrontation with experience to own group of patients. Material and methods: General assessment of etiology, pathophysology, diagnosis, clinical presentation, treatment options and prognosis of patients with FG on the basis of review of literature. Results and conclusions: Early diagnosis and immediate (< 24 hours), complete surgical excision and debridement are necessary to preserve the life of the patient. Delayed and/or inadequate surgical treatment have resulted in increased mortality. Concurrent (simultaneous) parenteral antibiotic (ATB) treatment should „cover“ all – inducing microorganisms and should penetrate in to the affected, inflamed tissue. The benefit of immunoglobulin therapy and hyperbaric oxygen remains unclear (uncertain). Only with early and aggressive surgical and ATB therapy, in combination with appropriate intensive care can be expected to survive for more than 70 % of patients with FG. After resolution of the acute phase it is necessary to plan and carry out the reconstruction of any defects (such as with the use of skin grafts). FGSI is a useful tool to evaluate the prognosis of patients with FG.

Keywords: Fournier´s gangrene, diagnosis, therapy, prognosis (FGSI score), own experience.