Fournier's gangrene. Immediate diagnosis and multimodality treatment is the comerstone for successful outcome.

BACKGROUND

Fournier's gangrene is a synergistic necrotic fasciitis or myositis of genitalia, perineum and abdominal wall. Several etiologic factors have been reported, microorganisms isolated and co-morbidity factors identified. Immediate and accurate diagnosis decreases mortality rate, which ranges from 3-67%. Aggressive resuscitation and surgical debridement consist the appropriate treatment.

MATERIAL AND

METHODS

Six cases of Fournier's gangrene treated the last ten years were reviewed. Three of them presented with mild infection while the other three with severe. The mean time interval between first symptoms and initial treatment was 2.1 days. The diagnosis was set immediately and the treatment included fluid-electrolyte resuscitation, aggressive surgical debridement, and broad-spectrum antibiotics administration.

RESULTS

All patients survived. The defects healed by second intention in four patients and only in two patients specific plastic reconstructive techniques were required. Hyperbaric oxygenation administrated in one patient induced surprisingly the healing of the lesion.

CONCLUSIONS

The Authors confirm that Fournier's gangrene is a rare and potentially fatal disease. Early suspicion, accurate diagnosis and multimodality treatment including aggressive surgical intervention are essential for successful outcome.