Fournier’s gangrene: a prospective study of 57 patients with special reference to validity of Fournier’s gangrene severity index in predicting the outcome and mortality

Authors

  • Pushpendra Kumar Shukla Department of Surgery, Shyam Shah Medical College Rewa, Madhya Pradesh
  • Ashish Ghanghoria Department of Surgery, Shyam Shah Medical College Rewa, Madhya Pradesh
  • Vinod Yedalwar Department of Surgery, Shyam Shah Medical College Rewa, Madhya Pradesh

DOI:

https://doi.org/10.18203/2349-2902.isj20161472

Keywords:

Fournier’s gangrene, Fournier’s gangrene severity index, Mortality

Abstract

Background:Fournier’s gangrene is a life-threatening necrotizing fasciitis of the perineal, genital and perianal region, which leads to thrombosis of the small subcutaneous vessels and results in the development of gangrene of the overlying skin. The aim of this study was to analyze the clinical and epidemiological characteristics of the patients with FG, discuss the validity of FGSI for predicting the disease severity and patient survival.

Methods: This is prospective study carried out in department of surgery of our institution between July 2011 to June 2014.The data were evaluated about medical history, symptoms, physical examination findings, vital signs laboratory tests, total body surface area involved, timing and extent of surgical debridement, and antibiotic treatment used. All the patients had radical surgical debridement. The Fournier’s gangrene severity Index was used in our study. This index calculates a score relating to the severity of the disease. The data were assessed according to whether the patient survived or died.

Results: Of the 57 patients studied, 13 died and 44 survived; the overall mortality was 22.8%. The survivors (mean age 57.78±11.16 years) were younger than the non-survivors (mean age 63.14±9.97 years) but it did not reach statistical significance (p=0.281). The median extent of the body surface area involved in the necrotizing process in patients who survive and did not survive was 2.8% and 4.8%, respectively (p=0.067). The abdominal wall involvement (22.72% vs 61.53% p=0.015) was associated with patient mortality. DM was most common comorbidity found in 24 (42.1%), most common predisposing factor is anorectal infection present in 21 (36.84%) patients.  Mean FGSI score was increased in patients who died compared to survivors (8.14±5.87 vs 4.21±4.3) but this difference was not significant (p=0.126).

Conclusions: Fournier’s gangrene is still a very severe disease with high mortality rates. The FGSI score did not predict the disease severity and the patient’s survival. For its proper treatment a high diagnostic suspicion and early recognition, surgical treatment and aggressive antibiotic therapy are still necessary.

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Published

2016-12-09

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Section

Original Research Articles