Fournier’s gangrene: clinic, diagnostics, treatment

The article provides a review of the literature about the problem of etiology, pathogenesis, clinical implications, characters of Fournier’s gangrene diagnostics, and experience of patients’ complex treatment that was accumulated in clinic.

Materials and methods. It is shown the results of treatment of 11 patients with Fournier’s gangrene aged from 18 to 75 years in the period from 1995 to 2015.

Results: During the first 2 days from the incursion of disease 4 patients (36.4 %) were admitted for treatment, in the period from 2 to 4 days – 7 patients (63.6 %) were also admitted. 9 patients (81.8 %) were presented by the fulminant disease progression (rapid progression) of Fournier’s gangrene with toxic shock syndrome. The average severity index of Fournier’s gangrene (Fournier's gangrene severity index or FGSI) was 9.1 points (varied from 0 to 15). The average FGSI for survived patients was 8.6 points, and for died patient - 12.6 points. 11 patients had microorganisms, which were exported from the focus; the spectrum of detected causative pathogen is notable for polymorphism. Limited wound defects of the scrota of 2 patients (18 %) were healed by secondary intention. For 4 patients (36 %) with extensive defects of scrota tissues and versatile exposure of testicles and funiculus spermaticus after wound cleansing there were reconstructed the scrota with closure of disemboweled organs by mobilized local tissues. Among 5 patients with common variant of Fournier’s gangrene 3 patients had a scrota reconstruction combined with surgical correction and autodermoplasty of perineum and perianal defects, and 2 patients had reconstruction combined with secondary suturation of wound defects on the abdominal parietes, inguinal region and right femoris. 1 patient (9.1 %) died as in consequence of the extension of putrid and necrotic process on the abdominal parietes, femoris and perineum tissues, rapid progression of endotoxicosis and multi-organ failure.

Conclusion. Therefore, the own experience of Fournier’s gangrene treatment testify that this severe infectious process is accompanied by rapid destruction of perineum tissues with its extension beyond the anatomical region, severe intoxication with significant deficiency of homeostasis, the Systemic Inflammation Response Syndrome combined with organ damage, indicating the development of sepsis in the majority of patients (severe sepsis, and, even, septic shock). 

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