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Al-Kohlany K, Baker K, Ahmed F, Mohamed M, Alshami M, Badheeb M. Treatment outcome of Fournier's gangrene and its associated factors: A retrospective study. Arch Ital Urol Androl 2023:11318. [PMID: 37254929 DOI: 10.4081/aiua.2023.11318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/25/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Fournier's gangrene (FG) is a rapidly progressive necrotizing infection that affects the perineal and abdominal regions and is known for its high mortality rate. This study aims to present the practical experience of managing FG patients and identify factors that may affect their clinical outcomes. MATERIALS AND METHODS A retrospective study was conducted from April 2009 to December 2020 at General Military Hospital in Sana'a, Yemen including 26 patients who were diagnosed with FG and treated on. Data on demographic characteristics, time to admission, surgical intervention, and treatment outcomes were collected. Univariate analysis was performed to determine factors that affect patient outcomes. RESULT The mean age of the patients was 65.77 ± 5.04 years, and 65.4% of them were over the age of 65. Most patients (57.7%) presented after five days of experiencing symptoms, and 65.4% were in septic conditions. Of the patients, 17 (65.4%) survived, and the total mortality rate was 34.6%. Univariate analysis showed that delayed presentation (p = 0.001), a history of diabetes mellitus (p < 0.001), end-stage renal disease (p < 0.001), heart failure (p < 0.001), cerebrovascular accident (p = 0.032), liver cirrhosis (p < 001), presence of multiple comorbidities (p < 001), involvement of lager area (p < 001), septic conditions (p = 0.009), advanced age (p = 0.018), and intensive care unit admission (p = 0.002) were found to be risk factors for mortality in patients with FG. CONCLUSIONS FG is a potentially life-threatening medical condition, even with aggressive and specialized treatment. Our study revealed a mortality rate of 34.6%. Factors such as older age, the presence of multiple comorbidities, septic conditions, the abdominal spread of the disease, intensive care unit admission, and delayed presentation contribute to higher mortality rates.
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Affiliation(s)
- Khaled Al-Kohlany
- Department of Urology, College of Medicine, Sana'a University, Sana'a.
| | - Khaled Baker
- Department of Urology, Sanus Hospital, Hradec Kralove.
| | - Faisal Ahmed
- Department of Urology, College of Medicine, Ibb University, Ibb.
| | | | - Majdi Alshami
- Department of Urology, General Military Hospital, Sana'a.
| | - Mohamed Badheeb
- Department of Internal Medicine, College of Medicine, Hadhramaut University, Mukalla.
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Noegroho BS, Adi K, Mustafa A, Haq RS, Wijayanti Z, Liarto J. The role of quick Sepsis-related Organ Failure Assessment score as simple scoring system to predict Fournier gangrene mortality and the correlation with Fournier's Gangrene Severity Index: Analysis of 69 patients. Asian J Urol 2023; 10:201-207. [PMID: 36942123 PMCID: PMC10023526 DOI: 10.1016/j.ajur.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/06/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Fournier's gangrene is a rare but life-threatening infection disease with high mortality rate. The quick Sepsis-related Organ Failure Assessment (qSOFA) is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome. The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier's gangrene patients. Methods This study is a case control with retrospective review of Fournier's gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria. Participants were divided into two groups according to qSOFA score as high qSOFA (2-3) and low qSOFA (0-1). Results From 69 patients, the mortality rate was 24.6%. The sensitivity of qSOFA score to predict mortality was 88.2%; the specificity was 94.2%; positive predictive value was 83.3%; negative predictive value was 96.1%; positive likelihood ratio was 15.2; negative likelihood ratio was 0.12; and the area under the receiver operating characteristic curve of qSOFA was 94.2%. There was significant association between qSOFA scale and mortality with p-value of 0.0001. The qSOFA score has strong positive correlation with Fournier's Gangrene Severity Index (p<0.0001, r=0.704). Conclusion qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier's gangrene patients.
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Mahmood BA, ElSayed EH, Ali SA. Effect of Colostomy on Treatment Outcome in Fournier Gangrene: A Prospective Comparative Study. Plast Surg (Oakv) 2023; 31:24-28. [PMID: 36755819 PMCID: PMC9900038 DOI: 10.1177/22925503211024757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Aim: Value of colostomy in management of Fournier gangrene (FG) is a debatable issue. Almost all relevant studies are retrospective and included heterogeneous patients' groups. The present prospective study aimed to evaluate the role of colostomy in management of FG affecting the perianal region in 2 well-matched FG groups. Patients and Methods: The present prospective comparative study included 30 patients with FG associated with extensive involvement of the perianal region. They comprised 15 patients subjected to colostomy and other 15 patients who refused to perform the procedure. Colostomy was performed after the first debridement. Outcome parameters in the present study included time to wound healing, length of hospital stay, and inhospital mortality. Results: Comparison between the studied groups regarding the preoperative characteristics revealed no statistically significant differences. Postoperatively, patients in the colostomy group had significantly fewer number of debridements (1.3 ± 0.5 vs 2.7 ± 1.2, P < .001), shorter hospital stay (9.5 ± 3.3 vs 29.9 ± 6.2 days, P < .001), and significantly shorter time to wound healing (16.5 ± 3.9 vs 42.9 ± 6.9 days, P < .001). Also, patients in the colostomy group had significantly lower rate of wound dehiscence, wound infection, and flap ischemia. However, the difference wasn't statistically significant. Conclusions: Aggressive treatment of FG aided by colostomy after first debridement would result in better clinical outcome.
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Affiliation(s)
- Barakat A. Mahmood
- Plastic and Reconstructive Surgery Department, Faculty of Medicine,
Helwan University, Cairo, Egypt
| | - Emad H. ElSayed
- Plastic and Reconstructive Surgery Department, Faculty of Medicine
(Girls), Al-Azhar University, Cairo, Egypt
| | - Sherif A. Ali
- General Surgery Department, Faculty of Medicine, Helwan University,
Cairo, Egypt
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Muacevic A, Adler JR, Guia Lopes ML, Camacho C. Fournier's Gangrene Mimicking Acute Epididymo-Orchitis in an Undiagnosed Diabetic Patient. Cureus 2022; 14:e32588. [PMID: 36654634 PMCID: PMC9840810 DOI: 10.7759/cureus.32588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Fournier's gangrene (FG) is an infectious disease characterized by necrotizing fasciitis of the perineal, perianal, or genital area associated with aging, male gender, diabetes mellitus (DM), alcoholism, trauma, and immunosuppression states. It can rapidly evolve into sepsis, septic shock, and multiorgan failure with a high mortality rate. We present the case of a 55-year-old man who developed a severe FG, initially assumed as an epididymo-orchitis with new-onset DM. The early identification and treatment resulted in a favorable outcome, being discharged from the hospital after 21 days. Diabetic patients are more susceptible to having severe infections such as FG, hence the importance of adequate metabolic control and increased suspicion to prevent fatal complications.
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Sanders SC, Balamohan A, Smith ES, Taylor MD, Cantu RM. Fournier's Gangrene: A Rare Infectious Entity in an Adolescent with Type II Diabetes. Glob Pediatr Health 2022; 9:2333794X221128416. [PMID: 36329836 PMCID: PMC9623360 DOI: 10.1177/2333794x221128416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022] Open
Abstract
Fournier's gangrene is a rapidly progressive necrotizing fasciitis of the perineum and external genital organs that is uncommon in the pediatric age group. We present a case report of a 17-year-old obese male with comorbidities of type II diabetes, hypertension, and tobacco use, who presented to the hospital with vague systemic symptoms and pain in the gluteal area. On examination, he was febrile and had erythema and induration of his left scrotum, perineum, and gluteal region. Imaging obtained due to rapid progression of symptoms was consistent with a diagnosis of Fournier's gangrene. He was managed with broad-spectrum antibiotics, aggressive surgical debridement, and a diverting colostomy. This case brings to light to a classically adult diagnosis that should be considered in adolescents, especially given the rising numbers of risk factors in this population, such as diabetes, obesity, and smoking.
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Affiliation(s)
- Sara C. Sanders
- University of Arkansas for Medical
Sciences, Little Rock, AR, USA,Arkansas Children’s Hospital, Little
Rock, AR, USA
| | - Archana Balamohan
- University of Arkansas for Medical
Sciences, Little Rock, AR, USA,Arkansas Children’s Hospital, Little
Rock, AR, USA
| | - Emily S. Smith
- University of Arkansas for Medical
Sciences, Little Rock, AR, USA,Arkansas Children’s Hospital, Little
Rock, AR, USA
| | - Maxwell D. Taylor
- University of Arkansas for Medical
Sciences, Little Rock, AR, USA,Arkansas Children’s Hospital, Little
Rock, AR, USA
| | - Rebecca M. Cantu
- University of Arkansas for Medical
Sciences, Little Rock, AR, USA,Arkansas Children’s Hospital, Little
Rock, AR, USA,Rebecca M. Cantu, Department of Pediatrics,
Arkansas Children’s Hospital, 1 Children’s Way, Slot 512-8, Little Rock, AR
72202, USA.
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Paladini A, Cochetti G, Tancredi A, Mearini M, Vitale A, Pastore F, Mangione P, Mearini E. Management of Fournier's gangrene during the Covid-19 pandemic era: make a virtue out of necessity. Basic Clin Androl 2022; 32:12. [PMID: 35850577 PMCID: PMC9294754 DOI: 10.1186/s12610-022-00162-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background Fournier’s gangrene (FG) is a necrotizing fasciitis caused by aerobic and anaerobic bacterial infection that involves genitalia and perineum. Males, in their 60 s, are more affected with 1.6 new cases/100.000/year. Main risk factors are diabetes, malignancy, inflammatory bowel disease. FG is a potentially lethal disease with a rapid and progressive involvement of subcutaneous and fascial plane. A multimodal approach with surgical debridement, antibiotic therapy, intensive support care, and hyperbaric oxygen therapy (HBOT) is often needed. We present the inpatient management of an FG case during the Covid-19 pandemic period. A narrative review of the Literature searching “Fournier’s gangrene”, “necrotizing fasciitis” on PubMed and Scopus was performed. Case presentation A 60 years old man affected by diabetes mellitus, with ileostomy after colectomy for ulcerative colitis, was admitted to our Emergency Department with fever and acute pain, edema, dyschromia of right hemiscrotum, penis, and perineal region. Computed tomography revealed air-gas content and fluid-edematous thickening of these regions. Fournier’s Gangrene Severity Index was 9. A prompt broad-spectrum antibiotic therapy with Piperacillin/Tazobactam, Imipenem and Daptomycin, surgical debridement of genitalia and perineal region with vital tissue exposure, were performed. Bedside daily surgical wound medications with fibrine debridement, normal saline and povidone-iodine solutions irrigation, iodoform and fatty gauze application, were performed until discharge on the 40th postoperative day. Every 3 days office-based medication with silver dressing, after normal saline and povidone-iodine irrigation and fibrinous tissue debridement, was performed until complete re-epithelialization of the scrotum on the 60th postoperative day. Conclusions FG is burdened by a high mortality rate, up to 30%. In the literature, HBOT could improve wound restoration and disease-specific survival. Unfortunately, in our center, we do not have HBOT. Moreover, one of the pandemic period problems was the patient’s displacement and outpatient hospital management. For all these reasons we decided for a conservative inpatient management. Daily cleaning of the surgical wound allowed to obtain its complete restoration avoiding surgical graft and hyperbaric oxygen chamber therapy, without foregoing optimal outcomes.
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Affiliation(s)
- Alessio Paladini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Giovanni Cochetti
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy.
| | - Angelica Tancredi
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Matteo Mearini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Andrea Vitale
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Francesca Pastore
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Paolo Mangione
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Ettore Mearini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
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Boran ÖF, Katı B, Fahri Pehlivan V, Boran M, Büyükfırat E, Buğra Bozan M, Barut O, Kutlu Demirkol M, Çiftçi H. Are there factors in the disease of peroneal necrotizing fasciitis which should be used when choosing the anesthetic technique?: Descriptive analysis of a cohort from two centers. ULUS TRAVMA ACIL CER 2022; 28:48-56. [PMID: 34967423 PMCID: PMC10443158 DOI: 10.14744/tjtes.2020.15088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study aims to examine the factors affecting the selection of anaesthesia method in Fournier's gangrene. METHODS A retrospective evaluation was made of 113 patients operated on because of Fournier's gangrene between January-May 2019. The operations were performed under spinal anaesthesia in 78 cases (Group S) and under general anaesthesia in 35 cases (Group G). The patients were evaluated regarding age, gender, the anaesthesia method used (spinal, general) anaesthetic agent applied, presence of sepsis, and biochemical, hematological and inflammatory parameters. RESULTS When the patients were evaluated regarding the Fournier Gangrene Severity Index (FGSI), patients in Group S had lower scores (p=0.001). Examination of the tomography images revealed that in 13 (37.1%) patients, air values were seen in the right or left gluteal area, or both, extending to the subcutaneous tissue. In the evaluation of the factors affecting the selection of general anaesthesia, a positive correlation was determined between an increase in FGSI (r=0.482, p=0.001) and the presence of sepsis (r=0.485, p=0.001) and gluteal region involvement (r=0.628, p<0.001). CONCLUSION The selection of anaesthesia method in Fournier gangrene patients is a complex process affected by factors, such as the patients' general condition, sepsis, and whether or not there is bleeding diathesis. The risk -benefit balance in the selection of anaesthesia method should be evaluated individually for patients.
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Affiliation(s)
- Ömer Faruk Boran
- Department of Anesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş-Turkey
| | - Bülent Katı
- Department of Urology, Harran University Faculty of Medicine, Şanlıurfa-Turkey
| | - Veli Fahri Pehlivan
- Department of Anesthesiology and Reanimation, Harran University Faculty of Medicine, Şanlıurfa-Turkey
| | - Maruf Boran
- Department of Intensive Care Unit, Amasya Şerefeddin Sabuncuoğlu Training and Research Hospital, Amasya-Turkey
| | - Evren Büyükfırat
- Department of Anesthesiology and Reanimation, Harran University Faculty of Medicine, Şanlıurfa-Turkey
| | - Mehmet Buğra Bozan
- Department of General Surgery, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş-Turkey
| | - Osman Barut
- Department of Urology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş-Turkey
| | - Mehmet Kutlu Demirkol
- Department of Urology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş-Turkey
| | - Halil Çiftçi
- Department of Urology, Harran University Faculty of Medicine, Şanlıurfa-Turkey
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Agwu NP, Muhammad AS, Abdullahi AA, Bashir B, Legbo JN, Mungadi IA. Pattern and outcome of management of Fournier's gangrene in a resource-constraint setting. Urol Ann 2020; 12:248-253. [PMID: 33100750 PMCID: PMC7546073 DOI: 10.4103/ua.ua_62_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Fournier's gangrene (FG) is a necrotizing fasciitis of the external genitalia and perineum but may involve upper thigh and anterior abdominal wall. PATIENTS AND METHODS This is a retrospective study of 47 patients managed for FG at Usmanu Danfodiyo University Teaching Hospital from January 2001 to June 2017. Data were entered into a semi-structured pro forma and analyzed using SPSS version 20.0. RESULTS The mean age of the patients was 42.7 ± 19.4 years, with age range of 7 weeks to 72 years. All the patients were male. The patients had underlying urologic conditions in 27.6%, 15.0% were postoperative, 4.2% had anorectal diseases, 10.6% had medical conditions, and 42.6% were idiopathic. After resuscitation, all the patients had serial debridement, Hypertonic saline bath, broad spectrum antibiotics and wound dressing. The wound healed by secondary intention in 34.0% and 32.3% of the patients had wound closure ± skin graft. The treatment was successful in 68.0% of the patients, 15.0% left against medical advice, and 17.0% died of severe sepsis. CONCLUSION FG mainly affects men with existing urologic conditions in our environment. Aggressive debridement, hypertonic saline sitz bath, broad-spectrum antibiotics, and appropriate wound care are associated with good outcome.
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Affiliation(s)
- Ngwobia Peter Agwu
- Department of Surgery, Urology, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Abubakar Sadiq Muhammad
- Department of Surgery, Urology, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Abdulwahab-Ahmed Abdullahi
- Department of Surgery, Urology, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Bello Bashir
- Department of General Surgery, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Jacob Ndas Legbo
- Department of Plastic and Reconstructive, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ismaila Arzika Mungadi
- Department of Surgery, Urology, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Zingaro MD, Boni A, Vermandois JARD, Paladini A, Lepri E, Ursi P, Cirocchi R, Turco M, Gaudio G, Nogara A, Mearini E. Fournier's Gangrene and Intravenous Drug Abuse: an Unusual Case Report and Review of The Literature. Open Med (Wars) 2019; 14:694-710. [PMID: 31934634 PMCID: PMC6947763 DOI: 10.1515/med-2019-0114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/09/2019] [Indexed: 12/29/2022] Open
Abstract
Fournier's gangrene is a potentially fatal emergency condition characterized by necrotizing fasciitis and supported by an infection of the external genital, perineal and perianal region, with a rapid and progressive spread from subcutaneous fat tissue to fascial planes. In this case report, a 52-year-old man, with a history of hepatitis C-virus (HCV)-related chronic liver disease and cocaine use disorder for which he was receiving methadone maintenance therapy, was admitted to the Emergency Department with necrotic tissue involving the external genitalia. Fournier's gangrene is usually due to compromised host immunity, without a precise cause of bacterial infection; here it is linked to a loco-regional intravenous injection of cocaine. A multimodal approach, including a wide surgical debridement and a postponed skin graft, was needed. Here we report this case, with a narrative review of the literature.
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Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Emanuele Lepri
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Pietro Ursi
- Department of General Surgery and Surgical Specialties “Paride Stefanini”;, Sapienza University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Division of General Surgery, Department of Surgical and Biochemical Sciences, University of Perugia, Perugia, Italy
| | - Morena Turco
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Andrea Nogara
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
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Nagano Y, Yakame NK, Aoki H, Yamakawa T, Kondo NI. Fournier's Gangrene in a Patient with Type 2 Diabetes Mellitus Treated with Empagliflozin: A Case Report. DRUG SAFETY - CASE REPORTS 2019; 6:11. [PMID: 31628552 PMCID: PMC6800415 DOI: 10.1007/s40800-019-0105-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been reported as possibly associated with Fournier’s gangrene (FG). This case report describes a 34-year-old Japanese man who was diagnosed with FG after the administration of empagliflozin for type 2 diabetes mellitus (T2DM). He presented with pain and swelling in the perineum and groin 142 days after initiating empagliflozin. The clinical features, laboratory data, and computed tomographic findings were consistent with FG. Surgical drainage and debridement of necrotic tissues were performed immediately after admission to our hospital. The patient had no complications of diabetes before the onset of FG. Glycemic management was good at the time of FG onset. This case suggests a possible association between empagliflozin and FG. We report a case of FG in a patient during a period of good glycemic management following treatment with empagliflozin. We recommend further awareness of this relationship and suggest the need for additional research.
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Affiliation(s)
- Yasunori Nagano
- Department of Pharmacy, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 1018326, Japan.
| | - Naomi Kashiwagi Yakame
- Department of Pharmacy, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 1018326, Japan
| | - Hisae Aoki
- Department of Surgery, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 1018326, Japan
| | - Tamaki Yamakawa
- Department of Endocrinology and Metabolism, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 1018326, Japan
| | - Naoko Iwahashi Kondo
- Department of Surgery, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 1018326, Japan
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Bocchiotti MA, Bogetti P, Parisi A, Rivarossa F, Frenello A, Baglioni EA. Management of Fournier's gangrene non-healing wounds by autologous skin micrograft biotechnology: a new technique. J Wound Care 2019; 26:314-317. [PMID: 28598758 DOI: 10.12968/jowc.2017.26.6.314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fournier's gangrene is an acute bacterial infection producing necrosis of the perineum and external genitalia that generally affects elderly men. Although skin grafts and flaps are the standard procedure for reconstruction, sometimes wounds can become chronic. Rigenera Protocol is a new technique based on autologous skin micrografts that reactivates and supports wound healing. A 40-year-old male with Fournier's gangrene, due to a rectal microperforation following diarrhoea, was treated with surgical debridement, negative pressure wound therapy and subsequently coverage with skin grafts. He developed non-healing wounds treated by Rigenera protocol after two months of advanced wound dressings. This technique is based on skin micrografts obtained by mechanical dermal disgregation to provide mesenchymal stem cells and extracellular matrix to the wound. The suspension injected into the wound triggers reactivation of healing without significant residual scarring on both donor site and treated area. Non-healing wounds were reduced by 15% at day 7 and by 50% after 30 days. Wounds completely healed after seventy days. The regenerated tissue appeared closer to skin graft than to scar tissue. This report shows how the use of skin micrografts through Rigenera protocol can be a useful method to reactivate wound healing resulting from Fournier's gangrene, with no discomfort for patient in a practical, safe and easy way.
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Affiliation(s)
- M A Bocchiotti
- Plastic Surgeon, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - P Bogetti
- Professor, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - A Parisi
- Resident, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - F Rivarossa
- Resident, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - A Frenello
- Resident, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - E A Baglioni
- Plastic Surgeon, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
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Fournier Gangrene: Association of Mortality with the Complete Blood Count Parameters. Plast Reconstr Surg 2018; 142:68e-75e. [PMID: 29952902 DOI: 10.1097/prs.0000000000004516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The authors studied the alterations in mean platelet volume, neutrophil-to-lymphocyte ratio, and red blood cell distribution width values together with the platelet count in hospitalized patients diagnosed with Fournier gangrene to determine their association with disease prognosis. METHODS Records of patients diagnosed with Fournier gangrene were analyzed retrospectively. RESULTS Seventy-four patients (49 men and 25 women) with a mean age of 57.60 ± 15.34 years (range, 20 to 95 years) were included. Sixty-eight participants were discharged and six died during follow-up. In the discharged group, during hospitalization, there was a trend downward in neutrophil-to-lymphocyte ratio and mean platelet volume values, whereas platelet count increased significantly. In the nonsurvivor group, the neutrophil-to-lymphocyte ratio and mean platelet volume after first débridement and at the end of hospitalization were significantly higher; platelet counts at admission, after the first débridement, and at the end of hospitalization were significantly lower compared with the survivor group (p < 0.05). In correlation analysis, mortality rate was negatively correlated with platelet count at admission and after first débridement and positively correlated with the neutrophil-to-lymphocyte ratio and mean platelet volume after first débridement. Regarding the receiver operating characteristic curve analyses, a platelet count of 188,500/µl at admission and 196,000/µl after the first débridement, a neutrophil-to-lymphocyte ratio of 13.71, and a mean platelet volume of 9.25 fl after the first débridement were defined as the cutoff levels having the best sensitivities and specificities. CONCLUSIONS This study suggests that platelet count at admission and platelet count, mean platelet volume, and neutrophil-to-lymphocyte ratio after first débridement and during discharge may be included among the prognostic scores of Fournier gangrene. The authors defined some threshold values that can be used during patient follow-up. Larger prospective studies are warranted to determine the exact role of those parameters in the prognosis of Fournier gangrene. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Ioannidis O, Kitsikosta L, Tatsis D, Skandalos I, Cheva A, Gkioti A, Varnalidis I, Symeonidis S, Savvala NA, Parpoudi S, Paraskevas GK, Pramateftakis MG, Kotidis E, Mantzoros I, Tsalis KG. Fournier's Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis. Front Surg 2017; 4:36. [PMID: 28740847 PMCID: PMC5502266 DOI: 10.3389/fsurg.2017.00036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/21/2017] [Indexed: 01/27/2023] Open
Abstract
Background Fournier’s gangrene (FG) is a rapidly evolving necrotizing fasciitis of the perineum and the genital area, the scrotum as it most commonly affects man in the vast majority of cases. It is polymicrobial in origin, due to the synergistic action of anaerobes and aerobes and has a very high mortality. There are many predisposing factors including diabetes mellitus, alcoholism, immunosuppression, renal, and hepatic disease. The prognosis of the disease depends on a lot of factors including but not limited to patient age, disease extent, and comorbidities. The purpose of the study is to describe the experience of a general surgery department in the management of FG, to present the multimodal and multidisciplinary treatment of the disease, to identify predictors of mortality, and to make general surgeons familiar with the disease. Methods The current retrospective study is presenting the experience of our general surgery department in the management of FG during the last 20 years. The clinical presentation and demographics of the patients were recorded. Also we recorded the laboratory data, the comorbidities, the etiology, and microbiology and the therapeutic interventions performed, and we calculated the various severity indexes. Patients were divided to survivors and non-survivors, and all the collected data were statistically analyzed to assess mortality factors using univariate and then multivariate analysis. Results In our series, we treated a total of 24 patients with a mean age 58.9 years including 20 males (83.4%) and 4 females (16.6%). In most patients, a delay between disease onset and seeking of medical help was noted. Comorbidities were present in almost all patients (87.5%). All patients were submitted to extensive surgical debridements and received broad-spectrum antibiotics until microbiological culture results were received. Regarding all the collected data, there was no statistically significant difference between survivors and non-survivors except the presence of malignancy in non-survivors (p = 0.036) and the lower hemoglobin (p < 0.001) and hematocrit (p = 0.002) in non-survivors. However, multivariate analysis did not reveal any predictor of mortality. Conclusion Early diagnosis, aggressive thorough surgical treatment, and administration of the proper antibiotic treatment comprise the cornerstone for the outcome of this disease. In small populations like in the present study, it is difficult to recognize any predictors of mortality and even the severity indexes, which take into account a lot of data cannot predict mortality.
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Affiliation(s)
- Orestis Ioannidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Loukiani Kitsikosta
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitris Tatsis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Skandalos
- Department of Surgery, General Hospital "Agios Pavlos", Thessaloniki, Greece
| | - Aggeliki Cheva
- Department of Pathology, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - Aikaterini Gkioti
- Department of Microbiology, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - Ioannis Varnalidis
- Department of Plastic Surgery, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - Savvas Symeonidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Natalia Antigoni Savvala
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Styliani Parpoudi
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George K Paraskevas
- Department of Anatomy, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Efstathios Kotidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Mantzoros
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Doluoğlu ÖG, Karagöz MA, Kılınç MF, Karakan T, Yücetürk CN, Sarıcı H, Özgür BC, Eroğlu M. Overview of different scoring systems in Fournier's Gangrene and assessment of prognostic factors. Turk J Urol 2016; 42:190-6. [PMID: 27635295 PMCID: PMC5012447 DOI: 10.5152/tud.2016.14194] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/29/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In this study we aimed to evaluate prognostic factors for the survival of patients with Fournier's gangrene (FG), and overview different validated scoring systems for outcome prediction. MATERIAL AND METHODS We retrospectively analyzed the data of 39 patients treated for FG in our clinic. Data were collected on medical history, symptoms, physical examination findings, vital signs, laboratory parameters at admission and at the end of treatment, timing and extent of surgical debridement, and the antibiotic treatment used. The Fournier's Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI) were used to predict outcome. The data were analyzed in relation with the survival of the patients. Mann-Whitney U test, chi -square test, Wilcoxon signed rank test, and Cox regression analysis were used for the statistical analysis. RESULTS Of 39 patients analyzed, 8 (20.5%) died and 31 (79.5%) survived. The median FGSI score on admission was 2 (0-9) for the survivors and 6 (2-14) for the non-survivors (p=0.004). The median CCI scores of the survivors and non-survivors were 2 (0-10) and 6.5 (5-11), respectively (p=0.001). Except for urea, albumin and hematocrit levels, no significant differences were found between survivors and non-survivors for other laboratory parameters on admission. Lower albumin levels and advanced age were found to be associated with mortality. CONCLUSION High blood urea, low albumin, and low hematocrit levels were associated with poor prognosis. High CCI and FGSI scores could be associated with a poor prognosis in patients with FG.
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Affiliation(s)
| | - Mehmet Ali Karagöz
- Clinic of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | | | - Tolga Karakan
- Clinic of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Cem Nedim Yücetürk
- Clinic of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Haşmet Sarıcı
- Department of Urology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
| | - Berat Cem Özgür
- Clinic of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Muzaffer Eroğlu
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Taken K, Oncu MR, Ergun M, Eryilmaz R, Demir CY, Demir M, Gunes M. Fournier's gangrene: Causes, presentation and survival of sixty-five patients. Pak J Med Sci 2016; 32:746-50. [PMID: 27375726 PMCID: PMC4928435 DOI: 10.12669/pjms.323.9798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: To report our experience with Fournier’s Gangrene (FG) over the past eight years and evaluate the predisposing factors which affect the mortality. Methods: Sixty-five patients who were admitted to emergency surgical unit of our institution presenting with FG between January 2006 and August 2014 were included. The anatomical site of infective gangrene, predisposing factors, etiological factors, and outcomes were retrospectively reviewed. Results: Our cases included 8 women and 57 men. The average age of men was 51±13.9 (range 19-75) and the average age of women was 63±10.5 (range 52-76). Average hospitalization time was 9.2±6.6 days (range 5-25) days. The most frequent comorbid disease was diabetes mellitus and the most frequent etiology was perianal abscess. Colostomy was performed in 11 patients, orchidectomy in two patients, cystostomy in two patients. Notably, all of the 8 (12.3%) patients who died from FG had diabetes and low socioeconomic status. A total of six patients who died required more than one surgical debridement. Conclusions: Fournier’s gangrene is a severe surgical emergency, with a high mortality rate. Low socioeconomic status, diabetes and more than one debridement play a major role in mortality and morbidity.
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Affiliation(s)
- Kerem Taken
- Kerem Taken, Department of Urology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Mehmet Resit Oncu
- Mehmet Resit Oncu, Department of Emergency, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Muslum Ergun
- Muslum Ergun, Department of Urology, State Hospital, Mus, Turkey
| | - Recep Eryilmaz
- Recep Eryilmaz, Department of Urology, State Hospital, Bitlis, Turkey
| | - Canser Yilmaz Demir
- Canser Yilmaz Demir, Department of Plastic Surgery, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Murat Demir
- Murat Demir, Department of Urology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Mustafa Gunes
- Mustafa Gunes, Department of Urology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
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Faria SN, Helman A. Deep tissue infection of the perineum: Case report and literature review of Fournier gangrene. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:405-407. [PMID: 27255622 PMCID: PMC4865338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Sarah N Faria
- Emergency physician at Headwaters Health Care Centre in Orangeville, Ont.
| | - Anton Helman
- Emergency physician at North York General Hospital in Toronto, Ont, Assistant Professor in the Division of Emergency Medicine at the University of Toronto, and Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Institute
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