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Fournier's gangrene: not as lethal as previously thought? A case series
Author(s) -
Heijkoop Bridget,
Parker Natalie,
Spernat Daniel
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14760
Subject(s) - medicine , gangrene , referral , fasciitis , perineum , surgery , mortality rate , fournier gangrene , retrospective cohort study , case fatality rate , tertiary referral centre , presentation (obstetrics) , tertiary referral hospital , clinical endpoint , tertiary care , pediatrics , necrotising fasciitis , randomized controlled trial , epidemiology , family medicine
Background Fournier's gangrene (FG) is a necrotizing fasciitis involving the perineum, external genitalia or perianal area. A rare condition with a historically high mortality rate (20–40%), our objective was to provide an up to date mortality rate for patients treated with multimodal therapy in a tertiary referral centre. Methods A retrospective review of a prospective database of FG patients treated at our tertiary referral centre was conducted. The primary end point was survival. Secondary end points included total hospital and intensive care unit (ICU) length of stay (LOS), number and type of procedures as well as considering co‐morbidities at presentation as potential predisposing factor. Results were compared to those in current literature. Results Between 2012 and 2017, 15 patients were diagnosed with FG at our tertiary referral centre. One was excluded as decision to palliate was made at presentation. Of the remaining 14 patients, 13 survived representing a mortality rate of 7%. In surviving patients, total LOS was between 10 and 71 days, with a mean LOS of 36 days and median LOS of 34 days. Eight required ICU with ICU LOS between 1 and 42 days, with a mean of 10 and median of 4. Number of debridement procedures ranged from 3 to 17 with a mean and median of 6. Six patients required adjunctive procedures and 10 required reconstructive procedures. Conclusion While a prolonged admission and multiple operations are expected, early diagnosis and aggressive multimodal treatment may result in a significantly better survival outcome than those quoted in previous literature.