Fournier Gangrene: From Infection to Reconstruction

Abstract

Introduction: Fournier gangrene is a rapidly extensive necrotizing fasciitis of high morbidity and mortality despite the progress of therapeutic means, it is a medical and surgical emergency requiring multidisciplinary management. The aim of our work was to study the epidemiological, clinical, paraclinical and therapeutic aspects of this pathology in order to identify prognostic factors of mortality, and exposing the contribution of plastic surgery. Methods: We conducted a retrospective, descriptive and analytical study on 40 cases of Fournier gangrene handled at the Nabeul University Hospital at the department of general surgery and plastic surgery during the period from January 2009 to December 2019. Results: Our series included 36 men and 4 women. The average age was 57 years old. Urogenital etiology was the most common. The average hopitalization time was 8 days and the mortality rate was 20%. Predictive factors mortality were: septic shock at admission, anemia below 9g/dl, hyperkalemia, renal failure, extent of necrosis beyond the pelvic region, and FMSI and U-FMSI scores. 7 patients received controlled wound healing, 9 had secondary sutures, 9 had skin grafts, and 7 had one or more flaps. Functional outcomes were good to very good for 80% of patients. Aesthetic results were good to very good for 70% of patients. Conclusion: A multidisciplinary and early treatment remains the best guarantee for obtaining  the best results in the management of Fournier gangrene. Mortality rates are improved by advances in surgery and resuscitation. The identification of prognostic factors is essential in order to establish optimal treatment.