Fournier’s gangrene in a modern surgical setting: improved survival with aggressive management

Objective To examine the outcome of 23 consecutive patients with Fournier’s gangrene. Patients and methods Patients’ charts were reviewed retrospectively from all those treated for Fournier’s gangrene between July 1994 and July 1997 at the UCLA affiliated hospitals. Results Twenty‐three patients were identified (mean age 51.7 years, range 13–71). The aetiologies included perirectal abscess (43%), urethral stricture (30%), scrotal abscess (21%) and unknown (4%). Predisposing factors included diabetes mellitus (43%), steroids or chemotherapy (21%), alcohol abuse (43%), malignancy (26%) and radiation therapy (9%). All 23 patients initially received wide debridement and placement of a percutaneous suprapubic tube. At the time of the first surgery, total scrotectomy was required in all, colostomy in 17% and penectomy in 4%. An additional 35% required eventual colostomy and an additional 9% required a penectomy. Patients underwent repeat debridement a mean of 2.5 times; the overall survival was 96%. Conclusion Survival can be improved in patients with Fournier’s gangrene by combining aggressive surgical and medical management. The keys to successful outcome included a high index of suspicion, prompt fluid resuscitation, rapid initiation of broad‐spectrum antibiotics, a multidisciplinary approach, early surgical intervention with radical debridement, haemodynamic support in an intensive care setting, and frequent repeat operative debridement.