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The limited impact of involved surface area and surgical debridement on survival in Fournier's gangrene
Author(s) -
PALMER L.S.,
WINTER H.I.,
TOLIA B.M.,
REID R.E.,
LAOR E.
Publication year - 1995
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1995.tb07676.x
Subject(s) - medicine , gangrene , total body surface area , body surface area , surgery , exact test , medical record , mortality rate , survival analysis
Objective To evaluate the influence of involved surface area (extent of disease) and the number and timing of surgical debridements on survival in patients with Fournier's gangrene. Patients and methods The medical records of 30 patients with Fournier's gangrene treated over a 15‐year period were reviewed. The extent of disease was quantified and expressed as a percentage of the body surface area by applying a modified diagram used to assess burn injuries. The number of surgical debridements and their timing with respect to initial presentation and to each other were also analysed. Patients were stratified by outcome (survival or death) and the data evaluated by Student's t‐test, Fisher's exact test and regression analysis. Results Of 30 patients treated 13 died (43%) and 17 survived (57%). The mean surface area involved by disease among survivors was 4.3% (range 1–16.5%) and 7.2% (range 5–20.5%) for non‐survivors (P = 0.10). Whilst no direct correlation between death rate and extent of disease existed, patients with <5% surface area involvement were more likely to survive (P = 0.014). Every patient underwent surgical debridement of the involved area (mean 1.72 procedures per patient). Survivors underwent from one to four debridements (mean 1.79) and non‐survivors one to three debridements (mean 1.63); the mean number of debridements did not influence outcome (P = 0.68). The performance of more than one debridement did not affect survival (P= 1.00). The initial debridement was performed within 24 h of presentation in 10 of 13 patients who died and 11 of 17 survivors and had no effect on outcome (P = 0.69). A second debridement was performed after a mean of 6.8 days (range 1–12) among the six survivors and 5.4 days (range 2–16) among the five non‐survivors; this difference was not statistically significant (P = 0.65). Four survivors required a third debridement, one required a fourth and one patient who succumbed underwent a third debridement. Conclusion The mortality rate from Fournier's gangrene continues to be substantial (43% in our series). Although no linear correlation existed, the quantified extent of disease may affect outcome as patients with > 5% of body surface area involved were more likely to succumb to the disease. Finally, the number of surgical debridements, even if first performed within 24 h of presentation, had no impact on outcome in patients with Fournier's gangrene.