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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Gangrena de Fournier
After initial radical debridement, open wounds are generally managed with sterile dressings or negative-pressure wound therapy. Singapore Med J Four of the nine patients experienced genital skin loss secondary to FG.
In regards to urinary diversion, some authors suggest cystostomy, although most suggest that urinary catheterization provides satisfactory diversion [ Yanar et al. After initial radical debridement, open wounds are generally managed with sterile dressings and negative-pressure wound therapy. The anaerobic bacteria promote the formation of clots by producing collagenase and heparinase.
Furthermore, length of stay was not affected by urinary or fecal diversion. Overall, the authors analyzed cases of FG at a total of hospitals. Conclusion FG is a rare necrotizing fasciitis of the perineal, genital and perianal region with an aggressive clinical course.
Czymek and colleagues prospectively collected data on 35 patients diagnosed with FG to assess the effectiveness of VAC therapy versus daily antiseptic polyhexadine dressings.
Colostomy has been used for fecal diversion in cases of severe perineal involvement. Excellent wound coverage and functional outcome was achieved in the seven patients who underwent reconstruction with this approach.
As mentioned previously, testicular involvement in FG is rare and suggests an intraabdominal or retroperitoneal source [ Eke, ]. Urologic sources of FG include urethral strictures, chronic urinary tract infection, neurogenic bladder, epididymitis and recent instrumentation [ Amendola et al.
In a retrospective study of 19 patients diagnosed with FG, Chawla and colleagues studied the utilization of the FGSI to determine length of stay and survival.
The diagnosis is often made clinically, although radiography can be helpful when the diagnosis or the extent of the disease is difficult to discern. The underlying cause of FG, such as a perianal fournief, a fistulous tract, or an intraabdominal or retroperitoneal infectious process, may also be demonstrated by CT [ Rajan and Scharer, ]. Cent Eur J Urol The aim fisiopatolpgia 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.
Moreover, the flap was found to be less bulky than a gracilis flap with minimal donor site morbidity [ Chen et al.
Gangrena de Fournier | Cigna
The infection in FG tends to spread along the fascial planes with dd involvement of the superficial Colles fascia and deep fascial planes of the genitalia.
Print Send to a friend Export reference Mendeley Statistics. Similar to other necrotizing soft tissue infections, the inflammation and edema from the polymicrobial infection lead to an obliterative endarteritis of the subcutaneous arteries [ Korkut et al.
The study of STSGs in the setting of denuded genitalia has been extensively studied and dates back to when Campbell first applied the technique to the testis after traumatic avulsion of the scrotum. 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.
Regardless, the authors still advocate rapid and timely surgical debridement [ Proud et al. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. Post Grad Med J Moreover, many have suggested adding penicillin for treatment of streptococci and, in particular, when Clostridia is suspected.
Int J Urol Also, this promotes and accelerates the formation of granulation tissue by removing bacterial contamination, end products, exudates and debris compared with traditional dressing [ Ozkan et al. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.
Various comorbidities are known to be associated with FG, of which DM is most common.
Contemporary diagnosis and management of Fournier’s gangrene
Mainstays of treatment include rapid and aggressive surgical debridement of necrotized tissue, hemodynamic support with urgent resuscitation with fluids, and broad-spectrum parental antibiotics. Pathogenesis and organisms involved The predisposing and etiologic factors of FG provide a favorable environment for the infection by decreasing the host immunity and allowing a portal of entry for the microorganism into the perineum.
Since the treatment of FG often requires highly acute and intensive multidisciplinary care, Sorensen and colleagues examined the difference in case severity and management between teaching and nonteaching hospitals. VAC therapy works by exposing a wound to subatmospheric pressure for an extended period to promote debridement and healing Figure 2 [ Mallikarjuna et al.
In a fisiopatoloogia review of 41 patients presenting with FG, Chen and colleagues found that scrotal advancement flaps provided good skin quality and cosmesis in small to medium sized scrotal defects.