Fournier's gangrene: 5 patients treated with hyperbaric oxygen

The classic syndrome of Fournier's gangrene was observed in 5 men with involvement of the external genitals and lower abdominal wall. Mixed flora of anaerobic and aerobic microorganisms were grown, and extensive necrosis of the skin and subcutaneous gas were present in all patients. Soon after hospitalization all 5 patients were treated by excision of all necrotic and undermined tissue, intravenous broad-spectrum antibiotics and hyperbaric oxygen administered at 3 atmospheres of pressure. One patient died of septic shock without any response to the therapy. The infection subsided shortly after the hyperbaric oxygen was instituted in the remaining 4 patients, who were cured. It is proposed that the treatment of Fournier's gangrene should be limited to centers capable of administering hyperbaric oxygen therapy. Our series does not prove that hyperbaric oxygenation is necessary for successful treatment but evidence suggests a beneficial effect of such therapy for nonclostridial gas gangrene.