FOURNIER'S GANGRENE: MANAGEMENT EXPERIENCE OF 39 CASES

Abstract

Objective: To determine the clinical presentation and management outcome
of Fournier's gangrene.
Methodology: This descriptive case series was carried out at the Department
of Urology, Lady Reading Hospital, Peshawar over a 5-years period. All patients
with Fournier's gangrene were included. The socio-demographic profile of the
patients, area of involvement, underlying co-morbids, survival versus death,
length of hospital stay and various surgical procedures undertaken were all
recorded on a proforma.
Results: Out of 39 patients, 89.74% (n=35) were males while 10.25% (n=4) were
females. The age range was 17-63 years with a mean of 46.20 ±13.32 years. Poor
general health/ malnutrition in 82.05% patients (n=32) was the commonest underlying
cause. Scrotum (n=35; 89.74%) was the most frequently involved body
area. The hospital stay was 7-63 days with a mean of 33.46 ±13.79 days. The
interventions undertaken included serial radical debridements (n=39; 100%),
split thickness skin grafts (n=19; 48.71%), direct closure of scrotal defects (n=9;
23.07%) and flaps (n=4; 10.25%). There were 07 mortalities (17.94% ).
Conclusion: Fournier's gangrene causes significant morbidity, hospitalization
and mortality in our population. Necrotizing fasciitis of the scrotum or perineum
is the usual presentation. Aggressive resuscitation and surgical excision of
the dead tissues followed by meticulous care of the surviving patient renders
the resultant defects manageable with skin grafts and flaps.