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Fournier's gangrene in a modern surgical setting: improved survival with aggressive management
J M Corman1, J A Moody, W J Aronson
1Department of Urology, UCLA School of Medicine, the Veteran's Administration Medical Centers, West Los Angeles, CA, USA. jcorman@u-washington.edu
Objective:
To examine the outcome of 23 consecutive patients with Fournier's gangrene.
Patients And Methods:
Patients' charts were reviewed retrospectively from all those treated for Fournier's gangrene between July 1994 and July 1997 at the UCLA affiliated hospitals.
Results:
Twenty-three patients were identified (mean age 51.7 years, range 13-71). The aetiologies included perirectal abscess (43%), urethral stricture (30%), scrotal abscess (21%) and unknown (4%). Predisposing factors included diabetes mellitus (43%), steroids or chemotherapy (21%), alcohol abuse (43%), malignancy (26%) and radiation therapy (9%). All 23 patients initially received wide debridement and placement of a percutaneous suprapubic tube. At the time of the first surgery, total scrotectomy was required in all, colostomy in 17% and penectomy in 4%. An additional 35% required eventual colostomy and an additional 9% required a penectomy. Patients underwent repeat debridement a mean of 2.5 times; the overall survival was 96%.
Conclusion:
Survival can be improved in patients with Fournier's gangrene by combining aggressive surgical and medical management. The keys to successful outcome included a high index of suspicion, prompt fluid resuscitation, rapid initiation of broad-spectrum antibiotics, a multidisciplinary approach, early surgical intervention with radical debridement, haemodynamic support in an intensive care setting, and frequent repeat operative debridement.