Fournier’s gangrene, an obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the overlying skin, is a rare but severe infective necrotizing. Profile of patients with Fournier’s gangrene and their clinical evolution. Perfil dos pacientes com gangrena de Fournier e sua evolução clínica. DJONEY RAFAEL. La gangrena de Fournier es una infección grave de la zona genital de los ciertas afecciones corren un mayor riesgo de llegar a tener gangrena de Fournier.

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More extensive techniques also exist and have successfully been applied to postradical debridement reconstruction of patients initially presenting with FG. Surg Clin North Am Insect bites, burns, trauma and circumcision have also been reported as causes of pediatric FG [ Amendola et al.

Interestingly, the mortality has been shown to be higher in technologically advanced countries such as the United States, Canada and Europe than in underdeveloped countries [ Eke, ]. Computed tomography CT plays an important role in the diagnosis of FG as well as the evaluation of the extent of the disease to guide appropriate surgical treatment. Am J Roentgenol Overall, the data in the study revealed that hospitals where more patients with FG are treated had lower mortality rates, supporting the need to regionalize care for patients with this disease [ Sorensen et al.

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Contemporary diagnosis and management of Fournier’s gangrene

Lee and colleagues described the use of unilateral gracilis muscle flap reconstruction combined with the internal pudendal artery perforator flap for reconstruction of extensive penoscrotal defects.

The Colles fascia is attached laterally to the pubic rami and fascia lata and posteriorly to the urogenital diaphragm, thus limiting progression in these directions. Fiisiopatologia gangrene is a urological emergency associated with a high mortality.

Urologic sources of FG include urethral strictures, chronic urinary tract infection, neurogenic bladder, epididymitis and recent instrumentation [ Amendola et al. Using a weighted point system of multiple laboratory markers, the Laboratory Risk Indicator for Necrotizing Fasciitis LRINEC score is often used to stratify patients into low, moderate or high risk for necrotizing soft tissue infections [ Wong et al.


Si continua navegando, consideramos que acepta su uso. Actas Urol Esp In 74 patients presenting with FG at an Egyptian medical center, adequate urinary diversion was accomplished with the use of a urethral Foley catheter fisiopatologiw all but one patient who had experienced a urethral injury.

Contemporary diagnosis and management of Fournier’s gangrene

This imaging modality is also useful in differentiating FG from inguinoscrotal hernias. In this case review, all four patients reported satisfaction with their cosmetic and functional results.

Am J Sur Etiology FG was initially defined as an idiopathic entity, but recent research has shown that less than a quarter of FG cases are now considered idiopathic [ Smith et al. As a whole, CT has greater specificity for evaluating disease extent than does radiography, US or even physical examination [ Rajan and Scharer, ]. Meanwhile, patients with large and deep perineal defects often needed a myocutaneous or fasciocutaneous flap to eliminate dead space. In regards to urinary diversion, some authors suggest cystostomy, although most suggest that urinary catheterization provides satisfactory diversion [ Yanar et al.

Alternatively, clindamycin and chloramphenicol can be substituted empirically to facilitate coverage of gram-positive cocci and anaerobes until culture results return [ Martinez-Rodriguez et al. Colorectal sources include local infection, abscesses particularly in the perianal, perirectal and ischiorectal regionsanal fissures, colonic perforations, diverticulitis, hemorrhoidectomy and rectal carcinoma [ Ash and Hale, ].

Conventional radiography can be used to detect the presence of soft tissue air in the area overlying the scrotum and perineum before clinical crepitus is detected. Conflict of interest statement: Please review our privacy policy. West J Em Med The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department.

Several case reports have demonstrated enhanced patient survival with the use of HBO in the setting of necrotizing fasciitis when combined with surgical debridement [ Jallali et al. Although diagnosis is straightforward when the lesions are found, failure to examine the genitals, especially in the older or obtunded patient, can result in misdiagnosis.


The mean hospital stay was Patients can rapidly deteriorate as sepsis and multiorgan failure, the most common cause of death in these cases, develop [ Sutherland and Meyer, ].

Temporary thigh pouches to harbor the testicles may be utilized in scenarios fourrnier significant tissue loss may preclude complex scrotal reconstruction in the acute setting Figure 4 [ Akilov et al. Subscriber If you already have your login data, please click here. Overall, US is considered superior to conventional radiography as soft tissue air is more obvious and scrotal contents along with Doppler blood flow can be examined.

All the patients were men, Therefore, it is recommended that stoma formation be reserved for patients with fecal incontinence caused by extensive damage to the anal sphincter [ Ozturk et al. A multidisciplinary approach is often necessary as these patients may require reconstructive procedures in the fisioparologia. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area.

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Acta Derm Vernereol Dis Colon Rectum Gangerna of treatment include rapid and aggressive surgical debridement of necrotized tissue, hemodynamic support with urgent resuscitation with fluids, and broad-spectrum parental antibiotics. Moreover, it was found that mean number of surgical debridements in survivors was lower compared with that of nonsurvivors. The cornerstones of FG treatment remain urgent extensive surgical debridement of all necrotic tissues, high doses of broad-spectrum gangrea and good supportive care.

Salvaging the testes is usually achieved by using techniques such as thigh pouches, skin grafts and use of fasciocutaneous or musculocutaneous flaps [ Corman et al. Crit Care Med VAC therapy works by exposing a wound to subatmospheric pressure for an extended period to promote debridement and healing Figure 2 [ Mallikarjuna et al.