Fournier’s gangrene, an obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the overlying skin, is a rare but severe infective necrotizing. Profile of patients with Fournier’s gangrene and their clinical evolution. Perfil dos pacientes com gangrena de Fournier e sua evolução clínica. DJONEY RAFAEL. La gangrena de Fournier es una infección grave de la zona genital de los ciertas afecciones corren un mayor riesgo de llegar a tener gangrena de Fournier.

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Treatment of FG entails treating sepsis, stabilizing medical parameters and urgent surgical debridement.

All the patients were men, No financial disclosures to report for other authors. Plast Reconstr Surg Acta Chir Belg Tightness around the corona or base of the penis during erection was reported but was found to have resolved after 6 months. Ferreira and colleagues reviewed 43 cases and found the most common presentations were scrotal swelling, fever and pain [ Ferreira et al.

Broad-spectrum parental antibiotic therapy is administered empirically upon diagnosis of FG and then subsequently tailored based on culture results.

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Si continua navegando, consideramos que acepta su uso. Conclusions Fournier gangrene is associated with high mortality despite appropriate early treatment.

FG is a rare necrotizing fasciitis of the perineal, genital and perianal region with an aggressive clinical course. It can help to evaluate both the superficial and the deep fascia, and to differentiate FG from less aggressive entities such as soft-tissue edema or cellulitis, which may appear similar to FG on physical examination.

The underlying cause of FG, such as a perianal abscess, a fistulous tract, or an intraabdominal or retroperitoneal infectious process, may also be demonstrated by CT [ Rajan and Scharer, ].


In addition, US can demonstrate paratesticular fluid, which is seen prior to clinical crepitus. Gsngrena the infection starts as a cellulitis adjacent to the portal of entry, commonly in the perineum or perineal region, with an insidious presentation.

fisiopafologia In their study of 44 patients presenting with FG, Ozturk and colleagues found that in 18 patients that required temporary stoma formation, significant increases in healthcare costs were observed without an effect on outcomes.

The relatively high incidence of FG in patients with diabetes has been attributed to fournir small vessel disease, defective phagocytosis, diabetic neuropathy and immunosuppression, all of which can be exacerbated by poor hygiene when present [ Vick and Carson, ]. In addition to broad-spectrum parental antibiotics, early and aggressive surgical debridement has been shown to improve survival in patients presenting with FG as patients often undergo more than one debridement during their hospitalization [ Corman et al.

Conclusion FG is a rare necrotizing fasciitis of the perineal, genital and perianal region with an aggressive clinical course. Go to the members area of the website of the AEDV, https: In women, additional sites of origin include Bartholin gland or vulvar abscess, episiotomy, hysterectomy and septic abortion [ Fisiopztologia et al. Meshed split-thickness skin graft with acceptable cosmetic result.

Gangrena de Fournier | Cigna

Singapore Med J Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. Alternatively, clindamycin and chloramphenicol can be substituted empirically to facilitate coverage of gram-positive cocci and anaerobes until culture results return [ Martinez-Rodriguez et al.

Other risk factors include extremes in age, malignancy, chronic steroid use, cytotoxic drugs, lymphoproliferative disease, malnutrition and human immunodeficiency virus HIV infection [ Mallikarjuna et flurnier. Cent Eur J Urol Moreover, response to treatment was found to be expedited in those treated with topical honey [ Efem, ].


Contemporary diagnosis and management of Fournier’s gangrene

The affected area is often swollen, dusky and covered by macerated skin and presents with a characteristic feculent odor, which is attributed to the role of anaerobes in the infection [ Alonso et al. Etiology was unknown in West J Em Med Overall, the authors state that VAC is not superior to conventional dressings in terms of length of hospital stay or clinical outcome.

In cases of severe perineal involvement, colostomy has been used for fecal diversion or alternatively, the Flexi-Seal Fecal Management System can be utilized to prevent fecal contamination of the wound. In this series, suprapubic cystostomy was recommended in patients experiencing urethral disruption or stricture [ Ghnnam, ]. Open in a separate window. Etiology FG was initially defined as an idiopathic entity, but recent research has shown that less than a quarter of FG cases are now considered idiopathic [ Smith et al.

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Contemporary diagnosis and management of Fournier’s gangrene

Moreover, it was found that mean number of surgical debridements in survivors was lower compared with that of nonsurvivors. Br J Surg A significant weakness of radiography in the diagnosis and evaluation of FG is the lack of detection of deep fascial gas [ Wysoki et al.

The inferior epigastric and deep circumflex iliac arteries supply the lower aspect of the anterior abdominal wall, whereas the external and internal pudendal arteries supply the scrotal wall.