Fournier Gangrene Publications (830)

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Fournier Gangrene Publications

2017Jan
Aesthetic Plast Surg
Aesthetic Plast Surg 2017 Jan 7. Epub 2017 Jan 7.
Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.

Necrotizing fasciitis (NF) is a rare, potentially fatal, infective complication that can occur after surgery. Diagnosis is still difficult and mainly based on clinical data. Only a prompt pharmacological and surgical therapy can avoid dramatic consequences. Read More

There are few reports regarding NF as a complication after aesthetic surgical procedures, and a systematic review still lacks.
We have performed a systematic review of English literature on PubMed, covering a period of 30 years. Keywords used were "necrotising fasciitis" matched with "aesthetic surgery complications", "breast surgery", "mammoplasty", "blepharoplasty", "liposuction", "facelift", "rhinoplasty fasciitis", "arm lift", "thigh lift", "otoplasty" and "abdominoplasty fasciitis". No additional search and temporal limitation were set.
Among 3782 papers concerning NF, only 18 were related to NF after an aesthetic surgical procedure. Liposuction was the most affected procedure, with buttocks and lower extremity the most involved anatomical regions. The majority of the infections were monomicrobial, promoted by Streptococcus pyogenes. In most cases, NF occurred within the third post-operative day with non-specific signs and symptoms. In 14 cases, a single or multiple surgical interventions were performed and survival was achieved in 11 patients.
In case of infection after aesthetic surgery, we should always bear in mind NF. Clinical hallmarks still guide NF management. Because early signs and symptoms are usually non-specific, a strict clinical control is highly suggested. Once clinical suspicion is raised, prompt antibacterial therapy should be administered, followed by surgical debridement in case of ineffective response.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

2016Dec
Arch Cardiol Mex
Arch Cardiol Mex 2016 Dec 13. Epub 2016 Dec 13.
Service of Cardiac Surgery, University Hospital Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain.
1969Dec
Urol J
Urol J 2016 12 8;13(6):2927-2929. Epub 2016 Dec 8.
Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim Hospital, Antwerp, Belgium.
2016Nov
J. Surg. Res.
J Surg Res 2016 Nov 15;206(1):175-181. Epub 2016 Jul 15.
Division of Trauma, Acute Care Surgery, Surgical Critical Care, LAC + USC Medical Center, Los Angeles, CA. Electronic address:

After surgical debridement, the use of fecal diversion systems (such as an endo-rectal tube or surgical colostomy) in Fournier's Gangrene (FG) to assist with wound healing remains controversial.
A 6-y retrospective review of a tertiary medical center emergency surgery database was conducted. Variables abstracted from the database include patient demographics, laboratory and physiological profiles, hospital length-of-stay, intensive care unit length-of-stay, operative data, time to healing, morbidity, and mortality. Read More


Thirty-five patients were treated. Seventy-seven percent (n = 27) required some form of fecal diversion (21 patients using an endo-rectal tube and six patients undergoing construction of a surgical colostomy). One patient had a pre-existing colostomy before the development of FG. The remaining seven patients underwent conservative wound care with multiple daily dressing changes (no diversion system). Twenty-eight of the 35 patients (80.0%) had long-term follow-up with 100% having completely healed surgical wounds at the final clinic visit. Average time to complete wound healing was 4.8 ± 1.0 mo (range, 1.0-31.0). Of the six patients who underwent colostomy formation, two had their colostomies reversed, two were unacceptable surgical risk and did not undergo reversal (due to uncontrolled diabetes and cardiovascular disease), and two were lost to follow-up. Of the two patients who had their colostomies reversed both had complications from their reversal (leak and urinary retention).
Surgical colostomy may not be mandatory (and might be associated with a high additional morbidity) in FG. With appropriate patient selection, it may be possible to avoid colostomy formation using a less-invasive diversion technology without compromising patient outcomes.

2016Nov
Mycopathologia
Mycopathologia 2016 Nov 2. Epub 2016 Nov 2.
Department of Pediatric Cardiac Surgery, Copernicus Hospital in Gdansk, Al. Jana Pawla II 50, 80-462, Gdansk, Poland.

Fournier gangrene is a rare, rapidly progressive, life-threatening condition. We report a 23-day-old boy with pulmonary atresia and ventricular septal defect treated surgically, who developed Fournier gangrene. Emergency surgery was performed with tissue sampling for microbiological examination. Read More

Candida albicans was confirmed; caspofungin followed by fluconazole was administered with excellent results.

2016Nov
Pan Afr Med J
Pan Afr Med J 2016 12;24:214. Epub 2016 Jul 12.
Service de Chirurgie, CHR Amadou Sakhir MBaye de Louga, Sénégal.

Acute scrotal swellings (ASS) are a common reason for emergency consultation. This study aims to determine the frequency of hospitalization for ASS at the Louga Amadou Sakhir Mbaye Regional Hospital, Senegal, to identify its clinical forms and to evaluate the care management.
This is a retrospective descriptive study involving 114 patients hospitalized for ASS at the Louga Amadou Sakhir Mbaye regional hospital, from May 2010 to August 2013. Read More

The variables studied were: the frequency of ASS among scrotal swellings and urological emergencies, age, consultation period, causes, treatment, post-treatment evolution and hospitalization length.
During the study period, 356 scrotal swellings and 420 urological emergencies were recorded. Thus, 114 cases with ASS accounted for 32.0% of scrotal swellings and 27.1% of urological emergencies. The average age was 42.25 ± 25 years (5 months and 89 years represent the extremes). The median of consultation time was 4 days. The diagnosis at admission was: acute orchiepididymitis (n=66), ASS with abscess formation (n=18), suspicion of torsion of the spermatic cord (n=14), traumatic ASS (10 cases), strangulated inguinoscrotal hernia (06 cases). Treatment was exclusively medical in 66 cases (57.8 %). Surgical exploration, which was indicated in 48 patients, was performed in 45 of them (93.7%), three patients (6.2%) refused it. In total there were 9 cases with orchiectomies and 36 conservative procedures. The average length of stay in hospital was 3 ± 2 days. Eighty-one patients (71.0%) were hospitalized for at least 24 hours. They were divided into two groups: 42 surgical patients and 39 medical patients. No deaths were recorded.
ASS are common in our hospital, people of all ages can be affected. They are dominated by ASS of infectious origin, torsion of the spermatic cord and scrotal trauma. Delayed consultation is often the rule, this may affect functional prognosis of the testicle.

2016Oct
Arch Ital Urol Androl
Arch Ital Urol Androl 2016 Oct 5;88(3):237-238. Epub 2016 Oct 5.
UO Urology, Santa Maria delle Croci Hospital, Ravenna.

Fournier's gangrene is a life-threatening acute necrotizing fasciitis of perianal,genitourinary and perineal areas. Nowadays, is well known that Fournier gangrene is almost never an idiopathic disease. In this article we report a case of a 70-year-old patient that initially was not treated properly. Read More

The gold standard therapy of the Fournier's gangrene remains today a complete, early and extended surgical debridement.

2016Oct
Arch Ital Urol Androl
Arch Ital Urol Androl 2016 Oct 5;88(3):157-164. Epub 2016 Oct 5.
MRC Centre for Transplantation, King's College London; Department of Urology, Guy's and St. Thomas' NHS Foundation Trust - King's Health Partners, London.

Fournier's gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. Read More

In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier's gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier's gangrene, in particular the various prognostic indicators and management strategies.
A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations.
Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier's gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients.
Fournier's gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available research as well as the lack of high quality evidence surrounding emergent therapies prevents their routine use in the management of Fournier's gangrene. The absence of a specific care pathway may hinder efficient management of Fournier's gangrene, thus based on current guidelines a management pathway is suggested.

2016Sep
Open Forum Infect Dis
Open Forum Infect Dis 2016 Sep 13;3(3):ofw148. Epub 2016 Jul 13.
Departments of Medicine.

Shewanella algae and Shewanella putrefaciens have been implicated for causing serious infections in humans, including disseminated infection. We report the possible first case of Shewanella-related Fournier's gangrene and bacteremia caused in a 65-year-old Chinese male with nephrotic syndrome. He was successfully managed by surgical debridement and antibiotic therapy. Read More

2016Oct

Fournier's gangrene (FG) is an acute progressive necrotizing fasciitis of the genital area and perineum with possible extension to the abdominal wall. Surgical debridement is the gold standard management modality of established patients. Equivocal (early) FG represents a challenge in diagnosis. Read More

The objective of this study was to compare conservative management and early exploration in cases of equivocal (early) FG.
This was an observational study where data of all patients diagnosed as early FG in our departments over 4 years (2011-2015) were enrolled. Patients were divided into two groups: group 1 with conservative treatment, and group 2 managed with urgent exploration with longitudinal hemiscrotal incision starting from external inguinal ring. All patients' demographics, vital signs, laboratory finding and clinical findings were reported.
A total of 28 patients were enrolled in the study. Group 1 was managed with conservative treatment (17 patients) and group 2 underwent urgent exploration (11 patients). Overall, four patients (23.5%) out of 17 patients of group 1 showed a good response to conservative management without any surgical debridement. A total of 13 patients (76.5%) developed gangrenous discoloration and needed surgical debridement later. In group 2, four patients (36.4%) underwent scrotal exploration and release incision only without debridement and showed an excellent clinical outcome. A total of four patients (36.4%) underwent debridement with excision of doubtful deep subcutaneous and fascial tissues. The remaining three patients (27.2%) underwent debridement of necrotic fascia. The hospital stay was significantly shorter in group 2 patients than group 1 (7.5 ± 3.75 versus 13.4 ± 5.19 days p < 0.05). The mean number of debridement sessions was 3.74 ± 0.69 in group 1 versus 1.82 ± 0.34 in group 2.
Early exploration and debridement in equivocal (early) FG has a better clinical outcome with reduced hospital stay and number of debridement sessions than conservative treatment with delayed debridement.