Philippine Journal of Surgical Specialties Vol. 68, No. 3, July-December 2013, pp 103-108

Surgical Management of Fournier’s Gangrene: A Seven-Year Experience at the Philippine General Hospital

Author(s): Marc Gil DL. Marcelo, M.D.; Lawrence Irving Bernardo, Marc Paul Lopez, M.D., F.P.C.S.; Marie Dione Sacdalan, M.D., F.P.C.S. and Manuel Francisco Roxas, M.D., F.P.C.S.

Fournier’s gangrene is the development of a progressive necrotizing infection in the genital and perianal region with findings of gangrenous and necrotic tissue involving the skin and subcutaneous tissue down to the fascia. This study aims to review cases of Fournier’s gangrene in the Hospital from 2004 up to 2010 and to provide a profile of patients afflicted with the disease and describe its surgical management in this institution.

A retrospective chart and database review was performed involving patients with a diagnosis of Fournier’s gangrene treated at the Hospital from 2004-2010. The following variables were analyzed: 1) total number of cases; 2) gender; 3) age range, distribution and mean age; 4) source of infection, whether the initial lesion started from the urogenital or perianal area; 5) associated co-morbid conditions; 6) the extent of infection, whether it’s confined to the urogenital or perineal area or has involved adjacent areas; 7) the time between initial symptoms to the first hospital consult; 8) number of debridement done at the operating room for each patient; 9) the presence of other surgeries aside from debridement; 10) outcome (recovered or expired).

The incidence of Fournier’s gangrene is 8.7 patients per year in our institution. There were 36 patients included in this study. There is a male preponderance, affecting 4 males for every 1 female. The mean age is 49.5 years with a range of 18-73. Sixty four percent had infection starting from the perianal area while the rest had an initial lesion from the urogenital area. Seventy two percent had lesions confined to the perianal/urogenital areas while the rest had extended infections. Diabetes mellitus was the most common comorbid condition, involving 47 percent of the cases. Majority of the patients (70%) underwent just a single debridement. Our institution mortality rate is 11 percent. No statistical significance was established between number of debridement and time of consult with mortality.

The optimal management of Fournier’s gangrene include all the ff: 1) appropriate anti-microbial therapy; 2) intensive pre and post-operative resuscitation; 3) aggressive and timely surgical intervention. While this disease may be rare, it always presents a challenge to the surgeon and the intensives, requiring a more thorough understanding of its presentation and treatment outcomes.

Key words: Fournier’s gangrene