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Fournier's gangrene: report of thirty-three cases and a review of the literature.
Int J Urol. 2006 Jul; 13(7):960-7.IJ

Abstract

BACKGROUND

Fournier's gangrene (FG) is an extensive fulminant infection of the genitals, perineum or the abdominal wall. The aim of this study is to share our experience with the management of this difficult infectious disease.

METHODS

Thirty-three male patients were admitted to our clinic with the diagnosis of FG between February 1988 and December 2003. The patient's age, etiology and predisposing factors, microbiological findings, duration of hospital stay, treatment, and outcome were analyzed. The patients were divided into two groups. The first 21 patients (Group I) were treated with broad-spectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning, and then they underwent split-thickness skin grafts or delayed closure as needed. The other 12 patients (Group II) were treated with unprocessed honey (20-50 mL daily) and broad-spectrum triple antimicrobial therapy without debridement. Their wounds were cleaned with saline and then dressed with topical unprocessed honey. The wounds were inspected daily and the honey was reapplied after cleaning with normal saline. Then, the patients' scrotum and penis were covered with their own new scrotal skin. The mean age of the patients was 53.9 +/- 9.56 years (range = 23-71).

RESULTS

The source of the gangrene was urinary in 23 patients, cutaneous in seven patients, and perirectal in three patients. The predisposing factors included diabetes mellitus for 11 patients, alcoholism for 10 patients, malnutrition for nine patients, and medical immunosuppression (chemotherapy, steroids, malignancy) for three patients. The mean duration of hospital stay was 41 +/- 10.459 (range = 14-54) days. Two patients in Group I died from severe sepsis. The clinical and cosmetic results were better in Group II than Group I.

CONCLUSION

Necrotizing fasciitis of the perineum and genitalia is a severe condition with a high morbidity and mortality. Traditionally, good management is based on aggressive debridement, broad-spectrum antibiotics, and intensive supportive care but unprocessed honey might revolutionize the treatment of this dreadful disease by reducing its cost, morbidity, and mortality.

Authors+Show Affiliations

Department of Urology, Gulhane Military Medical Academy, Ankara, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16882063

Citation

Tahmaz, Lutfi, et al. "Fournier's Gangrene: Report of Thirty-three Cases and a Review of the Literature." International Journal of Urology : Official Journal of the Japanese Urological Association, vol. 13, no. 7, 2006, pp. 960-7.
Tahmaz L, Erdemir F, Kibar Y, et al. Fournier's gangrene: report of thirty-three cases and a review of the literature. Int J Urol. 2006;13(7):960-7.
Tahmaz, L., Erdemir, F., Kibar, Y., Cosar, A., & Yalcýn, O. (2006). Fournier's gangrene: report of thirty-three cases and a review of the literature. International Journal of Urology : Official Journal of the Japanese Urological Association, 13(7), 960-7.
Tahmaz L, et al. Fournier's Gangrene: Report of Thirty-three Cases and a Review of the Literature. Int J Urol. 2006;13(7):960-7. PubMed PMID: 16882063.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fournier's gangrene: report of thirty-three cases and a review of the literature. AU - Tahmaz,Lutfi, AU - Erdemir,Fikret, AU - Kibar,Yusuf, AU - Cosar,Ahmet, AU - Yalcýn,Orhan, PY - 2006/8/3/pubmed PY - 2006/12/9/medline PY - 2006/8/3/entrez SP - 960 EP - 7 JF - International journal of urology : official journal of the Japanese Urological Association JO - Int J Urol VL - 13 IS - 7 N2 - BACKGROUND: Fournier's gangrene (FG) is an extensive fulminant infection of the genitals, perineum or the abdominal wall. The aim of this study is to share our experience with the management of this difficult infectious disease. METHODS: Thirty-three male patients were admitted to our clinic with the diagnosis of FG between February 1988 and December 2003. The patient's age, etiology and predisposing factors, microbiological findings, duration of hospital stay, treatment, and outcome were analyzed. The patients were divided into two groups. The first 21 patients (Group I) were treated with broad-spectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning, and then they underwent split-thickness skin grafts or delayed closure as needed. The other 12 patients (Group II) were treated with unprocessed honey (20-50 mL daily) and broad-spectrum triple antimicrobial therapy without debridement. Their wounds were cleaned with saline and then dressed with topical unprocessed honey. The wounds were inspected daily and the honey was reapplied after cleaning with normal saline. Then, the patients' scrotum and penis were covered with their own new scrotal skin. The mean age of the patients was 53.9 +/- 9.56 years (range = 23-71). RESULTS: The source of the gangrene was urinary in 23 patients, cutaneous in seven patients, and perirectal in three patients. The predisposing factors included diabetes mellitus for 11 patients, alcoholism for 10 patients, malnutrition for nine patients, and medical immunosuppression (chemotherapy, steroids, malignancy) for three patients. The mean duration of hospital stay was 41 +/- 10.459 (range = 14-54) days. Two patients in Group I died from severe sepsis. The clinical and cosmetic results were better in Group II than Group I. CONCLUSION: Necrotizing fasciitis of the perineum and genitalia is a severe condition with a high morbidity and mortality. Traditionally, good management is based on aggressive debridement, broad-spectrum antibiotics, and intensive supportive care but unprocessed honey might revolutionize the treatment of this dreadful disease by reducing its cost, morbidity, and mortality. SN - 0919-8172 UR - https://www.unboundmedicine.com/medline/citation/16882063/Fournier's_gangrene:_report_of_thirty_three_cases_and_a_review_of_the_literature_ L2 - https://doi.org/10.1111/j.1442-2042.2006.01448.x DB - PRIME DP - Unbound Medicine ER -