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Clin Nurse Spec 2019 Mar/Apr;33(2):E6

Clin Nurse Spec 2019 Mar/Apr;33(2):63-65

Author Affiliation: Nurse Researcher, Premier Health-Miami Valley Hospital, Dayton, Ohio.

Wounds 2019 Jan;31(1):E1-E4

Christus Trinity Mother Frances Hospitals, Tyler, TX.

Introduction: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) cleanses wounds with cyclic delivery, dwell, and removal of topical solutions to solubilize infectious materials and wound debris.

Objective: In this 2-patient case study, the authors report their experiences using NPWTi-d on 2 critically ill patients requiring management of large, complex wounds.

Materials And Methods: In both cases, normal saline was instilled with 10- to 20-minute dwell times, followed by 2 hours of negative pressure wound therapy (NPWT) at -125 mm Hg. Read More

J Diabetes 2019 Jan 2. Epub 2019 Jan 2.

Department of Endocrinology, Ankara Training and Research Hospital, Ankara, Turkey.

BMJ Case Rep 2018 12 7;11(1). Epub 2018 Dec 7.

Department of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts, USA.

We present a case of an unusual presentation of acute promyelocytic leukaemia (APML), which presented with Fournier gangrene (FG). A 38-year-old man presented with malaise, groin swelling, anal bleeding, fever and was found to have FG. Initial workup revealed pancytopaenia, borderline low fibrinogen, prolonged international normalized ratio (INR), which raised the suspicion for leukaemia. Read More

Ann Surg Treat Res 2018 Dec 26;95(6):324-332. Epub 2018 Nov 26.

Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea.

Purpose: We present our experience involving the management of this disease, identifying prognostic factors affecting treatment outcomes.

Methods: The patients treated for Fournier gangrene at our institution were retrospectively reviewed. Data collected included demographics, extent of soft tissue necrosis, predisposing factors, etiological factors, laboratory values, and treatment outcomes. Read More

Plast Reconstr Surg 2019 Feb;143(2):444e

Department of Plastic and Reconstructive Surgery, Yuzuncu Yil University Faculty of Medicine, Van 65040, Turkey,

Plast Reconstr Surg 2019 Feb;143(2):443e-444e

Department of Hematology, Ufuk University Faculty of Medicine Department of Internal Medicine, University of Health Sciences, Kecioren Training and Research Hospital, Ankara, Turkey.

Surg Infect (Larchmt) 2019 Jan 7;20(1):78-82. Epub 2018 Nov 7.

Faculty of Medicine, Department of General Surgery, Kirikkale University , Kirikkale, Turkey .

Background: The objective of this study was to determine the clinical and laboratory features affecting mortality in Fournier gangrene.

Patients And Methods: This retrospective case control study was designed to evaluate patients treated for Fournier gangrene in our center between 2010 and 2018. Those patients were divided into two groups: discharged patients (group 1) and deceased patients (group 2). Read More

Cent European J Urol 2018 22;71(3):360-365. Epub 2018 Sep 22.

University Medicine Greifswald, Department of Haematotology/Oncology, Greifswald, Germany.

Introduction: To compare earlier and later patient groups with Fournier's gangrene, specifically with the incidence of rising antibiotic resistance rates in mind. Primary endpoints were to compare therapy, outcomes, and resistance rates.

Material And Methods: A multicentric, retrospective, multi-national study was performed. Read More

Wounds 2018 Oct;30(10):290-299

Wright State University, Boonshoft School of Medicine, Division of Plastic Surgery, Dayton, OH.

Introduction: Fournier's gangrene (FG) remains a forbidding necrotizing soft tissue infection (NSTI) that necessitates early recognition, prompt surgical excision, and goal-directed antibiotic therapy. Traditionally, surgical management has included wide radical excision for sepsis control, but this management often leaves large, morbid wounds that require complex wound coverage, prolonged hospitalizations, and/or delayed healing.

Objective: The purpose of this case series is to report the outcomes of FG using a surrogate approach of concurrent debridement of spared skin and soft tissue, negative pressure wound therapy (NPWT), and serial delayed primary closure (DPC). Read More

BMC Surg 2018 Sep 24;18(1):77. Epub 2018 Sep 24.

Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China.

Background: Perineum necrotizing fasciitis, also known as Fournier gangrene (FG), is a rare but highly mortal infectious necrotizing fasciitis with or without involvement of the underlying muscle. Evidence exists that negative pressure wound therapy (NPWT) combined with a split thickness skin graft (STSG) can help to heal wounds with FG. However, when the wound spreads to the anal area, it can easily be contaminated by faeces, causing a more extensive wounds; thus, faecal diversion is considered. Read More

Forensic Sci Med Pathol 2019 Mar 19;15(1):155-158. Epub 2018 Sep 19.

Department of Forensic Medicine, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium.

Fournier gangrene is a rare fulminant necrotizing infection of the skin and soft tissue of the perineum that may result in rapid death. We describe the autopsy case of a 70-year-old female with uncontrolled diabetes mellitus who was found unexpectedly dead in her house where she lived with her dog. Examination of the body revelaed a deep necrotic ulceration of the perineum with exposure of the underlying deep muscles that was initially misinterpreted by police officers as post mortem animal predation. Read More

BMJ Case Rep 2018 Sep 19;2018. Epub 2018 Sep 19.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Ann Dermatol Venereol 2018 Nov 11;145(11):671-675. Epub 2018 Sep 11.

Clinique de dermatologie, hôpital Civil de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.

Background: Subcutaneous glatiramer acetate, commercialized under the name of Copaxone, is licensed for the treatment of relapsing multiple sclerosis. Its major adverse effects are skin reactions at the injection site. Nicolau syndrome is a rare but serious iatrogenic accident. Read More

Cleve Clin J Med 2018 Sep;85(9):664-665

Department of General Internal Medicine, Aso Iizuka Hospital, Fukuoka, Japan.

Pak J Med Sci 2018 Jul-Aug;34(4):1027-1029

Mehmet Oguz Sahin, M.D. Department of Urology, Manisa State Hospital, Manisa, Turkey.

Fournier's gangrene (FG) is a life-threatening, rapidly progressing acute necrotizing fasciitis of perianal, genitourinary and perineal areas. The most common isolated pathogens are , and in tissue and abscess cultures. However we present the first Rhizobium radiobacter FG in this case. Read More

Intern Med J 2018 09;48(9):1157-1160

Sydney, New South Wales, Australia.

Perineal gangrene (synergistic gangrene), an age-old severe infectious disorder, was more completely described by Dr Robert Robertson (1742-1829) in 1777, providing much needed data on the clinical features well before Dr Jean Alfred Fournier's (1832-1914) account in 1883. Robertson's historically overlooked and detailed narrative is presented with implications, in part, refuting some conclusions made by Fournier 100 years later. Read More

Urol J 2018 Aug 26. Epub 2018 Aug 26.

Department of female urology, Shahid Hasheminejad Hospital, Iran university of medical sciences, Tehran, Iran.

In this article we present two-year-old male patient who had history of Fournier gangrene of scrotum. Extensive perineal and scrotal debridement with suprapubic cystostomy tube insertion had been done for him in the emergency setting One year later his parents brought him back for scrotal reconstruction. A novel technique by using rotational perineal flap was used. Read More

ANZ J Surg 2018 Sep 2. Epub 2018 Sep 2.

Urology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.

Background: Fournier's gangrene (FG) is a necrotizing fasciitis involving the perineum, external genitalia or perianal area. A rare condition with a historically high mortality rate (20-40%), our objective was to provide an up to date mortality rate for patients treated with multimodal therapy in a tertiary referral centre.

Methods: A retrospective review of a prospective database of FG patients treated at our tertiary referral centre was conducted. Read More

AJR Am J Roentgenol 2018 Nov 7;211(5):1051-1057. Epub 2018 Aug 7.

1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110.

Objective: The objective of our study was to delineate CT findings and anatomic areas of involvement of surgically proven Fournier gangrene (FG) and determine interobserver reliability.

Materials And Methods: This study was a single-center retrospective study of patients with FG who underwent CT before surgical débridement of FG during a 9-year period. Thirty-eight patients with FG, 17 male and 21 female patients, underwent preoperative CT. Read More

Cir Cir 2018 ;86(4):327-331

Departamento de Urología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.

Antecedentes: La gangrena de Fournier (GF) es una fascitis necrotizante que pone en peligro la vida del paciente. El objetivo de este trabajo fue determinar la etiología y el impacto del agente aislado en el cultivo de la herida y de orina.

Método: Se llevó a cabo un análisis retrospectivo de una cohorte de 66 pacientes con GF de origen urogenital. Read More

Wounds 2018 Jul;30(7):E73-E76

Medical faculty, University in Ljubljana, Ljubljana, Slovenia.

Introduction: Fournier's gangrene is a rare but severe form of necrotizing fasciitis, primarily affecting the perianal, genital, and perineal regions. It is a rapidly progressive disease and can be potentially fatal; therefore, it should be treated as an emergency.

Case Report: Presented herein is the case of a 30-year-old man, without significant medical history, who presented to general surgery with complaints of swelling and pain in the gluteal area. Read More

Am J Emerg Med 2018 Sep 30;36(9):1719.e1-1719.e2. Epub 2018 May 30.

Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, United States; Northeastern Ohio Medical University, Rootstown, OH, United States. Electronic address:

Fournier's gangrene (FG) is a very serious and life threatening emergency. FG is a polymicrobial subset of necrotizing fasciitis affecting the genital region. Most cases have a perianal or colorectal focus; less often the gangrene originates from the urogenital tract or is preceded by trauma or a surgical procedure. Read More

Rev Bras Ortop 2018 Jul-Aug;53(4):493-498. Epub 2018 Jun 10.

Serviço de Ortopedia e Traumatologia, Grupo do Ombro e Cotovelo, Hospital Manoel Victorino, Salvador, BA, Brazil.

Fournier's gangrene is a rare, high-mortality infection that affects the subcutaneous tissue with rapidly progressive necrosis. The objective is to report a case of Fournier's gangrene involving the region of the shoulder girdle after closed fracture of the clavicle, and to discuss this unusual evolution. The patient underwent a series of surgical procedures and was followed up on an outpatient basis for 12 months, at which point she was discharged. Read More

Radiol Bras 2018 May-Jun;51(3):193-199

MD, PhD, Radiologist and Coordinator of the Imaging Department of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Emergencies involving the inguinal region and scrotum are common and can be caused by a plethora of different causes. In most cases, such conditions have nonspecific symptoms and are quite painful. Some inguinoscrotal conditions have high complication rates. Read More

World J Emerg Surg 2018 22;13:25. Epub 2018 Jun 22.

1Department of Urology, University Hospital Basel, Spitalstr. 21, 4031 Basel, Switzerland.

Background: Fournier's gangrene (FG) is a life-threatening infection of the genital, perineal, and perianal regions with a morbidity range between 3 and 67%. Our aim is to report our experience in treatment of FG and to assess whether three different scoring systems can accurately predict mortality and morbidity in FG patients.

Methods: All patients that were treated for FG at the Department of Urology of the University Hospital Basel between June 2012 and March 2017 were included and assessed retrospectively by chart review. Read More

Plast Reconstr Surg 2018 07;142(1):68e-75e

Van, Turkey From the Department of Plastic, Reconstructive, and Aesthetic Surgery and the Department of Anesthesiology and Reanimation, Yuzuncu Yil University Faculty of Medicine.

Background: The authors studied the alterations in mean platelet volume, neutrophil-to-lymphocyte ratio, and red blood cell distribution width values together with the platelet count in hospitalized patients diagnosed with Fournier gangrene to determine their association with disease prognosis.

Methods: Records of patients diagnosed with Fournier gangrene were analyzed retrospectively.

Results: Seventy-four patients (49 men and 25 women) with a mean age of 57. Read More

Urol Int 2018 27;101(1):91-97. Epub 2018 Jun 27.

Background: Fornier gangrene is an extremely rare disease of the genitals. This disease is a result of the urogenital tract, anorectal area, and genital skin infections, appearing usually in immunocompromised patients with diabetes, obesity, and malignant neoplasms. The basic treatment of Fournier gangrene includes an emergency surgical intervention combined with antibiotic therapy and detoxification. Read More

Dermatol Online J 2018 Apr 15;24(4). Epub 2018 Apr 15.

Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

Many cases of superinfected hidradenitis suppurativa (HS) involve multiple species of bacteria, but gas-producing infections are rare and can complicate the clinical picture. Additionally, recognizing squamous cell carcinoma (SCC) as a complication of longstanding HS is imperative. Herein, we present a unique case of a severe emphysematous HS that was initially mistaken for Fournier gangrene and eventually diagnosed as superinfected SCC. Read More

Surg Infect (Larchmt) 2018 Jul 12;19(5):467-472. Epub 2018 Jun 12.

2 Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine , Houston, Texas.

Background: Fournier's gangrene is a necrotizing soft-tissue infection (NSTI) that often originates from a break in bowel integrity and affects the perineum, anus, or genitalia. Although the pathogenesis is similar, NSTI caused by a break in bowel integrity less commonly presents as infection of other sites.

Objective: To characterize NSTIs originating from bowel perforation and presenting as infection of the abdominal wall, flank, or thigh but that largely spare the perineum, anus, and genitalia. Read More

Pan Afr Med J 2018 24;29:70. Epub 2018 Jan 24.

Service de Chirurgie Générale, Hôpital Habib Bougatfa de Bizerte, Tunisie.

Fournier gangrene is a rare and severe necrotizing fasciitis. It is burdened with high morbi-mortality, requiring early and massive medical and surgical management. Initial treatment is based on patient's resuscitation associated with surgical debridement. Read More

Med Gas Res 2018 Jan-Mar;8(1):29-33. Epub 2018 Apr 18.

Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.

Hyperbaric oxygen therapy (HBOT) is a medical technique which delivers oxygen at ambient pressures to increase the amount of dissolved oxygen in the blood and oxygen distribution to tissues. There are several beneficial properties of HBOT concomitant with elevated oxygen distribution in tissue including anti-inflammation, angiogenesis through vascular endothelial growth factor proliferation, augmented fibroblast activity through fibroblast growth factor proliferation, tissue and wound repair, enhancement of lymphocyte and macrophage activity, increased male testosterone secretion, and bactericidal activity. Given its renown in treating conditions such as decompression sickness and carbon monoxide poisoning, HBOT is making gradual strides for use in genitourinary medicine due to its low risk and likeliness to achieve favorable results. Read More

Georgian Med News 2018 Apr(277):57-60

Institute of Nephrology, Department of Internal Medicine, Struga, Macedonia.

The presented case reports on 54-years old patient with T2 Diabetes mellitus who, due to hypoglycemic episodes on Insulin therapy, was treated with oral anti-hyperglycemic medications. Patient was on hemodialysis due to the stage 5 chronic kidney failure and had various comorbid conditions: arterial hypertension, history of acute myocardial infarction, dilative cardiomyopathy, amaurosis and peripheral neuropathy. Besides his complicated medical history, patient developed an early stage of Fournier's gangrene. Read More

Zhonghua Nan Ke Xue 2017 Mar;23(3):237-242

Department of Urology, Research Institute of Field Surgery, Daping Hospital, The Third Military Medical University, Chongqing 400042, China .

Objective: To search for an optimal strategy for the treatment of penile and scrotal gangrene by analyzing the clinical effect of vacuum sealing drainage (VSD) as an adjuvant treatment on this disease.

Methods: We retrospectively analyzed the clinical data about 4 cases of penile and scrotal gangrene treated by VSD as an adjuvant treatment from January 2015 to June 2016. The 4 patients all underwent early extensive and radical debridement of gangrene of the scrotum and penis and received intravenous injection of two broad-spectrum antibiotics, followed by VSD for wound drainage and irrigation. Read More

Saudi Med J 2018 Apr;39(4):415-418

Department of Accident and Trauma, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.

Fournier gangrene is a rapidly progressive necrotizing fasciitis of the perianal and genitourinary area. Although typically affects men, we present here a rare disease founding in a pregnant woman. An obese 36-year-old female patient in her third trimester of pregnancy presented with a history of perianal pain and swelling. Read More

BMC Nephrol 2018 03 27;19(1):72. Epub 2018 Mar 27.

Department of Nephrology, Kameda Medical Center, Chiba, Japan.

Background: Vancomycin is the first-line antibiotic for methicillin-resistant Staphylococcus aureus and coagulase-negative strains. The risk of vancomycin-induced acute kidney injury increases with plasma vancomycin levels. Vancomycin-induced acute kidney injury is histologically characterized by acute interstitial nephritis and/or acute tubular necrosis. Read More

Oxf Med Case Reports 2018 Feb 26;2018(2):omx101. Epub 2018 Feb 26.

Department of Radiation Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus.

We herein present a case of a 24-year-old patient with a cT4N+ rectal cancer who developed Fournier's gangrene (FG) 1 week after the completion of preoperative chemoradiotherapy. The patient was promptly referred to the surgical department where she was treated with antibiotics and repeated surgical debridement. FG is a rare and life-threatening situation that needs to be managed aggressively with no delay. Read More

Oxf Med Case Reports 2018 Feb 9;2018(2):omx094. Epub 2018 Feb 9.

Department of Emergency Medicine, Beaumont Hospital, Teaching Hospital of Michigan State University, Farmington Hills, MI, USA.

Fournier's gangrene, a rare polymicrobial infection that affects the genitals and perineum, can present as an insidious onset to a rapid and fulminant course. Early recognition, diagnosis, initiation of broad-spectrum antibiotics and prompt surgical treatment remain the foundation of management. If treatment is not initiated aggressively, the patient will likely rapidly deteriorate, leading to organ failure and death. Read More

Plast Reconstr Surg Glob Open 2018 Jan 25;6(1):e1650. Epub 2018 Jan 25.

Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Surgery, Faculty of Medicine, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan.

Background: The use of negative-pressure wound therapy (NPWT) for Fournier gangrene management is well documented; however, it is difficult to fixate GranuFoam dressings and maintain an airtight seal over the perineum area. We developed a simple method to facilitate GranuFoam fixation and improve airtight sealing.

Methods: The Fournier's gangrene severity index (FGSI) score less than 9 was collected in from January 2015 to October 2016. Read More

Rev Col Bras Cir 2018 15;45(1):e1430. Epub 2018 Feb 15.

State University of Western Paraná, Cascavel, PR, Brazil.

Objective: to analyze the profile of patients with Fournier's gangrene treated in a public tertiary hospital in western Paraná State.

Methods: we conducted a cross-sectional, retrospective and descriptive study of patients with Fournier's gangrene treated between January 2012 and November 2016.

Results: there were 40 patients with Fournier's gangrene treated in the period, 29 (72. Read More

Rev Col Bras Cir 2018 15;45(1):e1389. Epub 2018 Feb 15.

Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.

Objective: to describe the use of a superomedial fasciocutaneous thigh flap for scrotal reconstruction in open areas secondary to the surgical treatment of perineal necrotizing fasciitis (Fournier's gangrene).

Methods: retrospective analysis of cases treated at the Plastic Surgery Service of Santa Casa de Misericórdia, São Paulo, from 2009 to 2015.

Results: fifteen patients underwent scrotal reconstruction using the proposed flap. Read More

Am Surg 2018 Jan;84(1):86-92

Necrotizing soft tissue infection of the perineum, or Fournier's gangrene (FG), is a morbid and mortal diagnosis. Despite the severity of FG, the optimal definitive wound closure strategy is unknown, as are long-term wound outcomes. A retrospective review was performed over a 3-year period at a single trauma center. Read More

GMS Interdiscip Plast Reconstr Surg DGPW 2018 15;7:Doc01. Epub 2018 Jan 15.

Plastic Surgery Center, Faculty of Medicine, Mansoura University, Egypt.

Fournier's gangrene is a necrotizing fasciitis caused by mixed aerobic and anaerobic bacteria and results in loss of skin and subcutaneous tissue in the perineal area. Coverage of testis varies from closure of the defect primarily, burying inside the thigh, using the remnants of the scrotum for tissue expansion and coverage by flaps. In this manuscript, scrotal advancement flaps and pudendal thigh flaps were used for coverage of the testis unilaterally or bilaterally according to the size of the defect following Fournier gangrene. Read More

Wounds 2018 Jan;30(1):E5-E8

National Hospital Organization Nagasaki Medical Center, Ohmura City, Japan.

Introduction: Fournier's gangrene (FG) is a type of necrotizing fasciitis of the perineum and scrotum that is characterized by very rapid progression. Sacral pressure ulcers are one of the causes of FG.

Case Report: An 85-year-old man was referred to the National Hospital Organization Nagasaki Medical Center (Ohmura City, Japan) with a diagnosis of FG extending to the retroperitoneum caused by a sacral pressure ulcer. Read More

Med Clin North Am 2018 Mar 20;102(2):373-385. Epub 2017 Dec 20.

Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue 16-703, Chicago, IL 60611, USA. Electronic address:

Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Read More

J Coll Physicians Surg Pak 2018 Feb;28(2):164-165

Department of Urology, R. G. Kar Medical College and Hospital, Kolkata, India.

skin and subcutaneous tissue. Penis may be secondarily affected in some cases; however, primary isolated involvement of penis is rare. A 48-year male smoker presented with pain and blackish discoloration of the distal part of penis for the last 4 days which developed following rupture of a papulo-vesicular lesion over the prepuce of penis. Read More

Med Sci Monit 2018 Jan 28;24:548-555. Epub 2018 Jan 28.

Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland.

BACKGROUND Fournier's gangrene (FG) is a fulminant form of infective, polymicrobial, necrotizing fasciitis of the perineal, genital, and perianal regions. It commonly affects men, but women and children may also develop this type of tissue necrosis. MATERIAL AND METHODS This study is a retrospective analysis of the management of 13 cases of Fournier's gangrene, diagnosed from among about 45 000 patients (men, women, and children) treated in the Department of General, Oncological, and Functional Urology (Medical University of Warsaw) from 1995 to 2013. Read More

J Plast Reconstr Aesthet Surg 2018 May 14;71(5):712-718. Epub 2017 Dec 14.

Department of Urology, University of Southern California, 1441 Eastlake avenue, Los Angeles, CA, USA 90030.

Background: There is no contemporary scoring system to predict hospital length of stay and morbidity in Fournier's gangrene. A retrospective study was conducted to formulate a scoring system to predict duration of hospitalization, resource utilization, need for reconstruction, morbidity and mortality.

Methods: A retrospective chart review was performed on 54 patients treated for FG from 2010-2016 at LAC+USC Medical Center, the largest public hospital in Los Angeles County. Read More