[Perineal gangrene: new bacteriologic approach. Results of medico-surgical treatment (81 cases)]

[Perineal-scrotal gangrene: epidemiological and therapeutic aspects. About 45 cases]

Perineoscrotal gangrene is an acute disease, a rare and severe affection of the perineum, whose evolution is unpredictable and rapidly extensive. The diagnosis is clinical. The paraclinical examinations allow early diagnosis and assessment of anatomical and biological repercussions. We conducted a retrospective study of 45 patients spread over six years, involving a multidisciplinary team consisting of three specialists (urologists, visceral, plastic surgeons). The average age was 52 years. The largely male dominated our series. Fournier gangrene was the most common etiology. We noted five cases of death (11%) in the acute phase, secondary to septic shock (four patients) or multiple organ failure (one patient). The evolution was favorable in 40 other patients in the series, requiring an initial management in intensive care unit, and surgical treatment. The average hospital stay was 17 days. After the acute phase, all patients underwent a surgery for skin coverage, ranging from guided healing (two patients) to musculocutaneous flap of the gracilis (six patients) via the secondary suture (four patients), the burying the testes (18 patients) and half thick skin graft, with a functional and aesthetic result was acceptable, and minimal sequelae. In our series, the most predictive prognostic factors would be the delay of care, sepsis on admission and associated diseases.

[Perineal gangrene: clinical and therapeutic features and prognostic analysis of 35 cases]

STUDY OBJECTIVE

The objective of this retrospective study of 35 cases of perineal gangrene was to describe their clinical and therapeutic features and to analyze the prognostic factors of mortality.

METHODS

From 1997 to 2004, 35 cases (25 men and 10 women, mean age=50.3 years) with perineal gangrene were treated in the "A" surgical department of Charles Nicole Hospital (Tunisia) with a combination of intensive care, antibiotic therapy, extensive excision and drainage, repeated if necessary and colostomy.

RESULTS

The mortality rate was 17.1%. The mean duration of hospitalization was 15.3 (range: 2-64) days. One patient had anal incontinence as sequelae. The colostomy in two patients was closed at the 9(th) and the 13(th) month. Statistical analysis showed that the extent of cellulitis, presence of myonecrosis, occurrence of septic shock need for postoperative mechanical ventilation, and IGSII and FGSIS severity scores differed significantly between patients who survived and those who died.

CONCLUSION

Perineal gangrene is still a very severe disease. The initial anatomic lesions, the IGSII and FGSIS severity scores and postoperative complications are the main prognostic factors of mortality.