Document Detail


The continuing challenge of Fournier's gangrene in the 1990s.
MedLine Citation:
PMID:  10597065     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Fournier's disease is a potentially fatal acute, gangrenous infection of the scrotum, penis, or perineum associated with a synergistic bacterial infection of the subcutaneous fat and superficial fascia. Thrombosis of small subcutaneous arterioles with resultant ischemia contributes to the rapid extension of the infection. During a 12-year period, the clinical and operative records of 14 patients with Fournier's gangrene were analyzed. All patients were treated with broad spectrum antibiotics and serial surgical debridements. Nine patients had polymicrobial isolates from the initial wound culture; two patients had Group A Streptococcus species as the sole isolate. The etiology of the infection was identified in 12 patients. Five patients died for an overall mortality of 38 per cent. The mean age of survivors was 51 years compared with 75 years for nonsurvivors (P<0.05). The last six patients in this series survived. The mean hospital stay was 29 days. Four patients (31%) had a prior history of diabetes; however, 11 patients (85%) had elevated serum glucose levels (>120 mg/dL) on admission. All patients were hypoalbuminemic on admission. Survivors had an average serum creatinine on admission of 1.28 mg/dL compared with 3.1 mg/dL for nonsurvivors. Although supportive care is required in these patients, the mainstay for treatment of Fournier's gangrene entails an aggressive approach with frequent and extensive soft tissue debridements to control the invasive nature of the infection with delayed wound coverage once the infection has been controlled. Elderly patients with evidence of renal dysfunction on admission have a poor prognosis despite aggressive therapy.
Authors:
J N Olsofka; E H Carrillo; D A Spain; H C Polk
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  65     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  1999 Dec 
Date Detail:
Created Date:  1999-12-23     Completed Date:  1999-12-23     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1156-9     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use
Blood Glucose / analysis
Cause of Death
Creatinine / blood
Debridement
Diabetes Complications
Fournier Gangrene / diagnosis*,  physiopathology,  surgery
Humans
Ischemia / physiopathology
Length of Stay
Male
Middle Aged
Penile Diseases / diagnosis
Perineum / pathology
Prognosis
Retrospective Studies
Scrotum / pathology
Serum Albumin / analysis
Streptococcal Infections / diagnosis
Streptococcus pyogenes
Survival Rate
Thrombosis / physiopathology
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Blood Glucose; 0/Serum Albumin; 60-27-5/Creatinine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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