Management of Fournier’s gangrene: our experience

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BACKGROUND: Fournier’s gangrene is a severe condition with a high mortality rate, requiring emergency surgical treatment. Improving its efficacy remains a pressing issue in urology and surgery.

AIM: To analyze the clinical course and treatment outcomes of Fournier’s gangrene.

MATERIALS AND METHODS: This article presents an analysis of the clinical course and treatment outcomes of 42 patients with Fournier’s gangrene treated in medical institutions in the Arkhangelsk region from 2005 to 2024. All patients were men aged 19 to 93 years (mean age 49.6 years).

RESULTS: Spread of gangrene beyond the genital area was observed in 36 patients (85.7%). The purulent process most frequently affected the perineal tissues (22 patients; 52.4%), often extending to the gluteal regions and pelvic soft tissues. Emergency surgical treatment was performed with excision of necrotic tissues. Subsequently, patients required staged surgical debridement at 1–2 day intervals. The number of these procedures ranged from 1 to 8. A total of 139 operations were performed (an average of 3.3 per patient). The maximum skin defect area was 467 cm2, and the length of the largest linear wound measured 109 cm. Seven patients (16.7%) required readmission for delayed reconstructive surgeries. These included urethral fistula repair in three cases, penile urethral stricture repair in one case, orchiopexy in two cases, and colostomy closure in one case. The mean period of hospital treatment was 32.6 days, with a mortality rate of 21.4%.

CONCLUSIONS: Hospitalization and initiation of treatment in patients with Fournier’s gangrene should be performed on an emergency basis. Excision of necrotic tissues must be radical, extending into healthy tissues during the initial and subsequent surgical debridement. The outcome of the condition largely depends not only on the timeliness and adequacy of therapeutic measures but also on the severity of immunocompromising predisposing factors and underlying diseases.

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作者简介

Sergey Bokovoj

Northern State Medical University

编辑信件的主要联系方式.
Email: sepalbok@mail.ru
ORCID iD: 0000-0003-3800-4130

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Arkhangelsk

Yurii Zverev

Arkhangelsk Regional Clinical Hospital

Email: zverevya@aokb.ru

MD

俄罗斯联邦, Arkhangelsk

Valerii Kremlev

First City Clinical Hospital named after E.E. Volosevich

Email: kremlevvv@mail.ru
SPIN 代码: 1977-3252

MD

俄罗斯联邦, Arkhangelsk

Sofia Yasheva

Northern State Medical University

Email: yashevasofi@mail.ru
ORCID iD: 0000-0001-7918-3580
SPIN 代码: 6605-8203

MD

俄罗斯联邦, Arkhangelsk

参考

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2. Fig. 1. Patient No. 1: a, scrotal edema with a “blue dot” sign; b, Fournier’s gangrene.

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3. Fig. 2. Patient No. 2: Extension of Fournier’s gangrene to the perineum.

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4. Fig. 3. Patient No. 3: Extension of Fournier’s gangrene to the anterior abdominal wall: a, before surgery; b, after surgery.

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5. Fig. 4. Patient No. 4: Extension of Fournier’s gangrene to the right thigh.

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6. Fig. 5. Patient No. 5: Limited defect of the scrotal skin.

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7. Fig. 6. Surgical treatment of Fournier’s gangrene. Excision of necrotic tissues and longitudinal incisions.

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8. Fig. 7. Surgical treatment of Fournier’s gangrene. Staged surgical debridement, excision necrotic foci.

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9. Fig. 8. Urethral fistula.

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10. Fig. 9. Subcutaneous transposition of the testes to the inner thighs.

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11. Fig. 10. Stabilization of the purulent-necrotic process.

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12. Fig. 11. Postoperative wound ready for defect closure.

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13. Fig. 12. Staged closure of the anterior abdominal wall defect using local tissues.

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14. Fig. 13. Closure of perineal and scrotal defects.

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15. Fig. 14. Scrotal repair with orchiopexy.

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16. Fig. 15. Split-thickness skin grafting of the penis using an autograft.

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17. Fig. 16. Burying of the penis in the scrotum (a), scrotal necrosis with penile exposure (b).

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