Fournier's gangrene: ten-year experience in a medical center in northern Taiwan

Background and Purpose: Fournier’s gangrene is a life-threatening infection. The mortality is still high despite the rapid advancement of modern intensive care and surgical technique. In this study, we present our institution’s recent experience with a large series of patients with Fournier’s gangrene. Methods: A retrospective chart review was performed including 44 consecutive patients with Fournier’s gangrene over a 10-year period. Results: The 44 cases comprised 39 males and 5 females, with a mean age of 55.5 years. The mean duration of hospitalization was 27.9 days. Overall mortality was 22.7%. Diabetes mellitus, hypertension, chronic liver disease, liver cirrhosis and chronic renal insufficiency were the 5 leading predisposing factors. Liver cirrhosis was highly related to mortality (p=0.009). The etiologic origin of the gangrene was colorectal, urological and dermatological in 52.3%, 25.0%, and 11.4% of patients, respectively. The most common isolated pathogens were Escherichia coli, Bacteroides fragilis, Klebsiella pneumoniae, Enterococcus spp., and Proteus mirabilis. There were a total of 74 debridements. Other related surgical procedures were reconstruction surgery (n = 18), colostomy (2), cystostomy (1), vasectomy (1), orchiectomy (1) and penectomy (1). Major complications of Fournier’s gangrene, including respiratory failure, renal failure, septic shock, hepatic failure and disseminated intravascular coagulopathy, were significantly to mortality (p<0.05). Conclusions: Early diagnosis, intensive medical care (aggressive resuscitation and broad-spectrum antibiotics), and prompt and repeated surgical intervention are the mainstays of treatment. Liver cirrhosis in particular is a poor prognostic factor. Reconstructive surgery should also be a consideration once the acute condition has improved. Patients with comorbid condition, serious infection, and major complications should be treated carefully and aggressively.