EXPERIENCE IN MANAGEMENT OF FOURNIER'S GANGRENE: A REVIEW OF 19 CASES

Background: Fournier's gangrene is a polymicrobial necrotizing fasciitis of the perineal, perirectal or genital area. The purpose of this study was to report our experience and results in the management of Fournier's gangrene. Patients & Methods: Retrospective review of charts of 19 consecutive patients of Fournier's gangrene treated between January 2005 and December 2008 in surgical unit, District Headquarter Teaching Hospital, D.I.Khan. Results: 19 male patients were identified (mean age 54.7 years, range 39-68 years). Etiology included anorectal in 21%, urogenital in 26.3%, cutaneous in 31.6% where as in 21% of cases the cause remained undetermined. Comorbid conditions were identified in 57.9% cases and included diabetes mellitus, chronic renal failure, malnutrition, cirrhosis and chronic steroid therapy. The most common organisms found on culture were Bacteroides fragilis, E coli, Streptococci and Staph aureus. The treatment plan was resuscitation, broad spectum intravenous antibiotics and multiple debridements (mean 2.9, range 1-8) per hospital stay (mean 26 days, range 10-52 days). Diversion procedures were also performed, which included cystostomy (15.8%) and colostomy (5.3%). Reconstructive measures included local skin flaps in 2 cases and split thickness skin grafts in 3 cases. The mortality rate was 10.5% (2 patients died due to severe sepsis). Conclusion: Early recognition of the pathology and aggressive surgical debridement are the mainstay of the management of Fournier's gangrene. Additional strategies to improve wound healing and increased patient survival are also needed.