Slovenská chirurgia 1-2e/2024

Fournier‘s gangrene – our ten-year clinical experience

Introduction: Fournier‘s Gangrene (FG) is an infectious necrotizing fasciitis affecting the perineal, perianal, and urogenital regions. The infection is caused by a combination of aerobic and anaerobic organisms. The mortality rate of the disease can reach up to 88%. Patients and methods: From 2014 to 2023, a total of 16 patients with Fournier‘s Gangrene were operated on at the Surgical Clinic of Pavol Jozef Šafárik University in Košice, Medical Faculty, AGEL Hospital Košice-Šaca. Among them, 9 were men and 7 were women, with an average age of 63.31 years. The aim of the study was to retrospectively evaluate the observed parameters in the group of patients with Fournier‘s Gangrene and establish optimal treatment management. Results: In the patient file, a mortality rate of 31.25% was recorded. Mortality in the female part of the population was 42.85%, on the other hand, mortality in men was 22.22%. The cause of death was multiorgan failure in three cases (60%) and sepsis in two cases (40%). In 60% of deceased patients, a combination of risk factors was noted: arterial hypertension (AH), type II diabetes mellitus (DM II), and obesity. Genital involvement in the form of vulvar and scrotal abscesses was observed in 9 patients (56.25%), and perianal abscess as the triggering cause of the disease was recorded in 6 patients (37.5%). Due to severe involvement of the perianal area and rectum, terminal sigmoidostomy was performed in five patients (31.25%). The most commonly administered antibiotic combination was cephalosporin and metronidazole (50%). Considering extensive soft tissue defects, reconstructive procedures were necessary for 3 surviving patients (27.27%). Conclusion: Early diagnosis followed by maximally radical surgical intervention in conjunction with a dual combination of antibiotic therapy is the optimal treatment for halting the rapidly progressing Fournier‘s Gangrene and may lead to a reduction in its mortality. Only after managing the acute phase of the disease and achieving a stabilized local condition is it possible to proceed with the reconstruction of soft tissue defects.

Keywords: Fournier‘s gangrene, risk factors, surgical treatment