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Revista Cubana de Cirugía

Print version ISSN 0034-7493

Abstract

FUENTES VALDES, Edelberto; NUNEZ ROCA, Ariel; KAPAXI ANDRADE, Josina  and  FERNANDES DA CUNHA, Yacira. Fournier's gangrene. Rev Cubana Cir [online]. 2013, vol.52, n.2, pp.91-100. ISSN 0034-7493.

Introduction: Fournier's gangrene is a rare and serious disease, which is characterized by necrotizing, synergistic and polymicrobial fasciitis and maintains high mortality. Objective: to contribute to a better knowledge about the individual diagnosis, treatment and prognosis of this rare disease. Methods: Seven patients who were treated from February 2010 to April 2011 were studied. Demographic data, associated diseases, etiology, treatment, complications and mortality were evaluated as well as the time with probe and hospital stay. Results: the patients were men with a mean age of 43, 3 years; the youngest was 30 years old and the oldest was 49. The associated diseases were: acquired immunodeficiency syndrome (2), diabetes mellitus (1), and hypertension (1). The origins were perineal (4) and scrotal (3). Three patients reported to have perineal fistulas or abscesses. The time of evolution fluctuated between 6 and 30 days. Clinical manifestations were characterized by pain, increase in volume in perineal or scrotal regions or both and fetid secretion. Crepitation was found when the disease occupied the inguinal regions and the abdominal wall. Surgical treatment required debridement and digestive derivations (colostomy), urinary derivations (cytostomy) or both. The number of interventions varied between three and seven. Surgical reconstruction of the perineum and scrotum was practiced, using skin grafts in the survivors. Three patients (42.9 %) presented complications: septic shock, multiple organ failure and late urethral stricture (1). A patient who had been admitted with manifestations of septic shock died (14.3 %). Conclusions: the success of the treatment is achieved with the early diagnosis, early aggressive surgical debridement, and broad-spectrum antibiotic therapy.

Keywords : Fournier's gangrene; necrotizing fascitis; debridement; surgical intervention.

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