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1.
World J Emerg Surg ; 13: 25, 2018.
Article in English | MEDLINE | ID: mdl-29977327

ABSTRACT

Background: Fournier's gangrene (FG) is a life-threatening infection of the genital, perineal, and perianal regions with a morbidity range between 3 and 67%. Our aim is to report our experience in treatment of FG and to assess whether three different scoring systems can accurately predict mortality and morbidity in FG patients. Methods: All patients that were treated for FG at the Department of Urology of the University Hospital Basel between June 2012 and March 2017 were included and assessed retrospectively by chart review. Furthermore, we calculated Fournier's Gangrene Severity Index (FGSI), the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and the neutrophil-lymphocyte ratio (NLR) in every patient and assessed whether those scores correlate with the patients' morbidity and mortality. Results: Twenty patients were included, with a median (IQR) age of 66 (46-73) years. Fifteen of twenty (75%) patients required treatment on an intensive care unit, and three died (mortality rate: 15%). The mean FGSI, LRINEC, and NLR scores were 13.0, 9.3, and 45.3 for non-survivors and 7.7, 6.5, and 26 for survivors, respectively. None of the risk scores correlated significantly with mortality; however, all three significantly correlated with infection- and surgically-induced morbidity. Conclusions: In our series, Fournier's gangrene was associated with a mortality rate of 15% despite maximum multidisciplinary therapy at a specialized center. All risk scores were able to predict the morbidity of the disease in terms of local extent and the required surgical measures.


Subject(s)
Fournier Gangrene/classification , Fournier Gangrene/mortality , Severity of Illness Index , Aged , Female , Fournier Gangrene/epidemiology , Humans , Male , Middle Aged , Risk Factors , Statistics, Nonparametric , Switzerland/epidemiology , Tertiary Care Centers/organization & administration , Tertiary Care Centers/statistics & numerical data
2.
Urology ; 84(5): 1217-22, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25135870

ABSTRACT

OBJECTIVE: To classify defects in the penoscrotal region according to their specific anatomic sites. METHODS: From January 2002 to December 2012, 20 male patients underwent reconstruction for penoscrotal defects. The causative factors were Fournier's gangrene in 12 patients, extramammary Paget's disease in 4, skin tumors in 3, and deformity after a burn injury in 1. The defects were categorized according to their anatomic location: penis (P), and right (r) and left (l) scrotum (Sr and Sl), inguinal area (Ir and Il), and perianal area (Ar and Al). RESULTS: Seven patients with defects in the penis received skin grafts. Defects affecting more than 2 anatomic regions or extensive defects (>100 cm(2)) were reconstructed by free tissue transfer. Other defects were reconstructed by perforator-based island flap coverage. All of the flaps survived without complications. CONCLUSION: We introduce a classification that provides a simple way to specify the anatomic location and extent of a defect. This classification will permit more effective and straightforward reconstruction in the penoscrotal region.


Subject(s)
Fournier Gangrene/surgery , Paget Disease, Extramammary/surgery , Penile Neoplasms/surgery , Plastic Surgery Procedures/methods , Skin Neoplasms/surgery , Adult , Aged , Burns/surgery , Fournier Gangrene/classification , Humans , Male , Middle Aged , Paget Disease, Extramammary/classification , Penile Neoplasms/classification , Penis/surgery , Retrospective Studies , Scrotum/surgery , Skin Neoplasms/classification , Skin Transplantation/methods , Surgical Flaps
3.
Chirurg ; 83(11): 943-52, 2012 Nov.
Article in German | MEDLINE | ID: mdl-23011149

ABSTRACT

Necrotizing soft tissue infections are caused by a variety of pathogens and may affect different types of soft tissue. Even today mortality and lethality are very high. The primary symptoms of necrotizing soft tissue infections are local pain out of proportion, swelling, erythema and crepitation in cases of subcutaneous gas. A systemic inflammatory response syndrome (SIRS) is often associated. During the last decades early recognition and initiation of an adequate therapy were able to reduce lethality to an average of 20%. The physical examination remains the diagnostic gold standard and may be supported by typical findings of imaging technologies, e.g. subcutaneous gas on x-rays and laboratory tests. After diagnosis an adequate antibiotic and surgical therapy should be performed immediately.


Subject(s)
Skin Diseases, Bacterial/classification , Skin Diseases, Bacterial/diagnosis , Soft Tissue Infections/classification , Soft Tissue Infections/diagnosis , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Connective Tissue/pathology , Connective Tissue/surgery , Debridement , Diagnosis, Differential , Fasciitis, Necrotizing/classification , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/pathology , Fasciitis, Necrotizing/surgery , Fournier Gangrene/classification , Fournier Gangrene/diagnosis , Fournier Gangrene/pathology , Fournier Gangrene/surgery , Gas Gangrene/classification , Gas Gangrene/diagnosis , Gas Gangrene/pathology , Gas Gangrene/surgery , Humans , Necrosis , Skin/pathology , Skin Diseases, Bacterial/pathology , Skin Diseases, Bacterial/surgery , Soft Tissue Infections/pathology , Soft Tissue Infections/surgery , Systemic Inflammatory Response Syndrome/classification , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/pathology , Systemic Inflammatory Response Syndrome/therapy
4.
Klin Khir ; (5): 31-4, 2009 May.
Article in Russian | MEDLINE | ID: mdl-19957746

ABSTRACT

The experience of treatment with favorable outcome of 3 patients, in whom gangrene of Fournier was diagnosed, was summarized.The necessity of application of "agressive" surgical tactics in early terms of the disease was stressed.


Subject(s)
Fournier Gangrene/classification , Fournier Gangrene/surgery , Genitalia, Male/surgery , Urologic Surgical Procedures, Male/methods , Aged , Fournier Gangrene/diagnosis , Fournier Gangrene/etiology , Fournier Gangrene/physiopathology , Genitalia, Male/blood supply , Genitalia, Male/pathology , Humans , Male , Microcirculation/physiology , Middle Aged , Necrosis , Treatment Outcome
5.
J Chir (Paris) ; 140(1): 22-32, 2003 Feb.
Article in French | MEDLINE | ID: mdl-12709649

ABSTRACT

The global mortality for Fournier's gangrene is one in five. In half the cases, the infection is polymicrobial with either anaerobes or gram negative bacilli. Factors which worsen prognosis include renal insufficiency, streptococcal infection, or need for hospital admission. Diagnosis must be prompt and treatment multidisciplinary involving the surgeon, intensivist, and infectious disease specialist; early and adequate surgical debridement must be accompanied by well-chosen antibiotics and hyperbaric oxygen therapy. Post-debridement therapy requires a long period of dressing changes and skin grafting to achieve final wound closure. This is an aggressive disease with a high mortality, but the depth and extent of invasive infection does not determine prognosis; the first priority is prompt and wide surgical excision/debridement of infected tissues to pre-empt the development of systemic sepsis; this should not be deferred while arranging transfer to a facility with a hyperbaric chamber.


Subject(s)
Fournier Gangrene , Anti-Bacterial Agents/therapeutic use , Debridement , Fournier Gangrene/classification , Fournier Gangrene/diagnosis , Fournier Gangrene/microbiology , Fournier Gangrene/mortality , Fournier Gangrene/surgery , Fournier Gangrene/therapy , Humans , Hyperbaric Oxygenation , Male , Perineum , Postoperative Care , Prognosis , Risk Factors , Tomography, X-Ray Computed
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