scholarly journals Management of peno-scrotal wound defects in a tertiary hospital in North-Western Nigeria: a 20-year retrospective review

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Abubakar Sadiq Muhammad ◽  
Ngwobia Peter Agwu ◽  
Abdullahi Abduwahab-Ahmed ◽  
Ahmed Mohammed Umar ◽  
Muhammad Ujudud Musa ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Graft Loss ◽  
External Genitalia ◽  
Tertiary Hospital ◽  
Advancement Flap ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Direct Closure ◽  
Secondary Intention ◽  
North Western

Abstract Background Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. The management of these patients includes initial resuscitation and subsequent wound care with or without wound cover. The aim of this study is to document our experience in the management of peno-scrotal defects in a tertiary hospital of North-Western Nigeria. Methods This is a 20-year retrospective study of patients managed for peno-scrotal wound defects by the Urology Unit in the Department of Surgery of our hospital from January 2001 to December 2019. Data were collected from the patients’ case notes and entered into a proforma. Data were analysed using SPSS version 25.0. Results A total number of 54 patients with peno-scrotal wound defects were managed within the study period with the mean age of 46.27 ± 22.09 years and a range of six weeks to 107 years. The wound defects were sequelae of Fournier’s gangrene in 42 patients (77.8%) and traumatic in 12 patients (22.2%). Healing by secondary intention was achieved in 20 patients (37.0%). Direct closure was done in 17 patients (31.5%), skin graft in nine patients (16.7%), and advancement flap in eight patients (14.8%) depending on the location and size of the defects. Fourteen patients (26.0%) developed surgical site infection ± wound dehiscence and partial graft loss. The complication rate was higher in post-Fournier’s gangrene wound defects, but without statistical significance (p = 0.018). Conclusion Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. Smaller wound defects were healed by secondary intention, while larger defects required either direct closure or the use of advancement flap or skin grafting depending on the location and size of the wound. The study reported a higher post-repair complication in patients that had Fournier’s gangrene.

scholarly journals Treatment of a case of Fournier’s gangrene after a perianal abscess debridement

2020 ◽  
Vol 4 (02) ◽  
pp. 1-3
Author(s):  
Madan Bhandari ◽  
Naveen Rao ◽  
Prasanna Narasimha Rao ◽  
B. J. Gopikrishna
Keyword(s):  
Perianal Abscess ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
Cow Milk ◽  
Contributing Factors ◽  
Fournier's Gangrene ◽  
Scrotal Pain ◽  
Secondary Intention ◽  
Healing Property ◽  
Many Sources

Fournier’s gangrene is rapidly progressive and potentially fatal infective necrotising fasciitis affecting the external genitalia, perineal or perianal regions. Among many sources of infection, perianal surgical manipulation is one of the major contributing factors. A 45-years diabetic patient who had recently undergone surgical debridement elsewhere to treat a perianal abscess visited SDM Ayurvedic hospital with mild scrotal pain and an unhealthy surgical wound. He was treated surgically with broad-spectrum antibiotics, strict control of hyperglycemia, regular minimum debridement of wound and dressing with a Yashtimadhu taila (an herbal oil with Glycyrrhiza glabra, Emblica officinalis, Sesamum indicum and cow milk as active ingredients) famous for its wound healing property. The patient gradually recovered and the wound was gradually healed with secondary intention.

Fournier’s gangrene due to Salmonella Typhimurium in a healthy male: a rare aberrant infection

2020 ◽  
Vol 20 ◽  
Author(s):  
Varsha Gupta ◽  
Lipika Singhal ◽  
Kritika Pal ◽  
Mani Bhushan ◽  
Rajeev Sharma ◽  
...  
Keyword(s):  
Salmonella Typhimurium ◽  
Systemic Disease ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
The Body ◽  
Healthy Male ◽  
Fournier's Gangrene ◽  
Salmonella Infections ◽  
Chief Complaints ◽  
Human Infections

Introduction: Human Salmonella infections have been classically distinguised into diseases caused by typhoidal and non-typhoidal salmonella (NTS). Typhiodal salmonella includes S. enterica serovars Typhi and Paratyphi that cause the systemic disease but are restricted to human infections, while NTS consists mainly of other serovars that predominantly cause self-limiting gastroenteritis in humans. Localisation of foci with persisting infection occurs due to dissemination of the bacteria throughout the body and can cause a variety of rare clinical syndromes at aberrant sites. Fournier’s gangrene, a rapidly progressive, often fatal, necrotizing fasciitis of the external genitalia and perineum due to Salmonella Typhimurium, is a rare manifestation and has never been reported. Case: A 22-year-old male, apparently healthy patient with no relevant past medical history presented to surgical emergency with chief complaints of swelling of bilateral scrotal area. Infective etiology was considered and a diagnosis of fournier’s gangrene was made. Pure growth of Salmonella Typhimurium was obtained after repeated subculture and was identified biochemically and on serotyping, as Salmonella enterica serotype Typhimurium using specific antisera. Conclusion: In our case report, we describe a case of fournier’s gangrene due to Salmonella Typhimurium in an otherwise healthy male to highlight the unusual presentation of Non typhoidal salmonellae at an aberrant site. We also emphasize the importance of using selective media like Selenite F broth for isolation of Salmonella Typhimurium from a pus sample.

scholarly journals Clinico-Pathological Profile and Management Outcome of Fournier’s Gangrene in a Tertiary Care Hospital

2018 ◽  
Vol 9 (2) ◽  
pp. 124-130
Author(s):  
Mahmud Ekram Ullah ◽  
Amreen Faruk ◽  
Rajibul Haque Talukder ◽  
Farukuzzaman ◽  
Noor A Alam
Keyword(s):  
Tertiary Care ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
Care Hospital ◽  
Fournier's Gangrene ◽  
Predisposing Factor ◽  
Medical College ◽  
Number Of Patients ◽  
Variable Extent ◽  
Surgery Department

Background: Fournier’s gangrene is a vascular disaster of infective origin occurring about male external genitalia. Diabetes Mellitus is an important predisposing factor. A good number of patients of this rare clinical entity are admitted frequently in our centre. Till now the disease has the potential for significant morbidity and also mortality.Objective: The study was designed to be conducted among patients suffering from Fournier’s gangrene to identify the possible source of sepsis, to denote pattern and extent of area involvement and microorganisms isolated and to observe the treatment course and outcome.Methods: This prospective observational study was carried out in BIRDEM General Hospital, Dhaka among 60 patients of Fournier’s gangrene admitted under surgery department during the period of October 2016 to January 2018 using purposive sampling method.Result: The results of this study suggest that majority of the study population were in 51 to 60 years (Mean 52±4.9) age group. All the patients were diabetic with grossly elevated blood glucose level (Mean RBS=17.3 mmol/dl). In addition to scrotum, perineum, penis, buttock and lower abdomen were also affected to variable extent (73.3%). All patients required major debridement which had to be repeated in 68.3% cases. Steptococcus pyogens was the most common organism isolated (43.3%) followed by Eschericia coli (35%) and majority were of polymicrobial type (61.6%). Mortality rate was 8.3%.Conclusion: The diagnosis and treatment of Fournier’s gangrene is enigmatic and challenging to the physician. Urgent surgical debridement along with other appropriate supportive measures can reduce morbidity and mortality.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 124-130

scholarly journals Emergency management and it’s effect on clinical profile of Fournier’s gangrene in patients presenting at a rural setup

2019 ◽  
Vol 6 (12) ◽  
pp. 4397
Author(s):  
Tausif Kamal Syed ◽  
Dilip K. Apturkar ◽  
K. N. Dandekar
Keyword(s):  
Serum Creatinine ◽  
Emergency Management ◽  
Leucocyte Count ◽  
External Genitalia ◽  
Severity Index ◽  
Fournier’S Gangrene ◽  
Total Leucocyte Count ◽  
P Value ◽  
Fournier's Gangrene ◽  
Soft Tissue Necrosis

Background: Fournier’s gangrene (FG) is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. This study describes our experiences in the management of FG and identifies prognostic factors.Methods: It is a descriptive prospective study in 71 patients with FG treated at Pravara Rural Medical College and Hospital, Loni, who presented between September 2013 and September 2015.Results: In the present series of 71 patients, 57% were between 50-70 yrs. UTI and alcohol consumption being most common co-morbid conditions and scrotal abscess (53.52%) being the most common presentation. Serum creatinine (p value 0.0008), total leucocyte count at presentation (p value 0.004) had a significant association with duration of recovery. The mean duration of stay was 16.08±3.28 days with a median of 15 days. The Fournier gangrene severity index score calculated was <9 in 59.15% of patients, and >9 in the remaining ≈40% with a mean of 8.309±3.49. A single mortality was recorded during our study.Conclusions: Serum creatinine and total leucocyte count at presentation could play a pivotal role in not only initial emergency management but also as factors for monitoring the progress of treatment.

scholarly journals Fournier’s Gangrene: 10-Year Experience of a Plastic Surgery and Burns Department at a Tertiary Hospital

2019 ◽  
Vol 32 (5) ◽  
pp. 368 ◽  
Author(s):  
João Mendes Louro ◽  
Miguel Albano ◽  
João Baltazar ◽  
Miguel Vaz ◽  
Carla Diogo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Escherichia Coli ◽  
Length Of Stay ◽  
Plastic Surgery ◽  
Tertiary Hospital ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Fournier Gangrene ◽  
Number Of Patients ◽  
Reconstructive Techniques

Introduction: Fournier gangrene is a polymicrobial life threatening infection of perineal subcutaneous soft tissues with its point of origin in urologic, colorectal or skin diseases. Although more frequent in elderly and men, it can affect all genders and age groups. Perianal abscess, diabetes mellitus and Escherichia coli are the most frequent cause, predisposing comorbidity, and microorganism found in tissue culture analysis respectively. The objective of this study was to describe the experience of a Plastic Surgery Department of a tertiary Hospital in reconstructing Fournier’s gangrene perineal defects and its detailed demography.Material and Methods: The sample is composed of all patients with Fournier gangrene admitted in the Plastic Surgery and Burns Department. The authors retrospectively collected and analyzed demographic and clinical data during a period of 10 years including gender, age, length of stay, cause, number of debridements, predisposing factors, microbial culture results, surgical reconstructive techniques and its associated complications, additional surgical procedures and outcomes.Results: Fifteen patients were identified: 14 males (93%) and one female (7%); mean age was 66.9 years (range: 46 - 86); mean, length of stay was 46.8 days (range: 20 - 71 days) and mean number of debridements was 3.3 (range: 1 - 4). The most frequent predisposing factor was diabetes mellitus, the major cause was perianal (n = 2) and skin abscess (n = 2). Eight (53.3%) patients had no identifiable source of Fournier gangrene. Various types of reconstructive techniques were employed; and 5 additional surgical interventions (33.3%) were undertaken (one cystostomy, two orchidectomy, two ileostomy); six patients (40%) presented reconstructive technique complications with adequate final outcome.Discussion: In contrast with the literature, where Escherichia coli was the most frequently isolated agent, Staphylococcus aureus was the most frequent microorganism found in tissue biopsy/pus collection analysis. A higher than expected number of patients (n = 8) had no identifiable source of Fournier gangrene. This findings can be explained by the retrospective non-multicentre study limitation, with a potencial source of bias patients that were transferred from other hospitals in advanced stage, without point of origin of Fournier’s gangrene identified.Conclusion: Early recognition and extensive necrotic tissue debridement, along with prompt and adequate antimicrobial treatment, are the mainstay of Fournier gangrene management, thus reducing morbidity and mortality in these patients. Surgical reconstruction challenges derived from this condition should be addressed by specialized teams due to the risk of dysfunctional sequelae and conspicuous deformities. Taking in account the single-center and retrospective observational character of the present study, these premises require proper validation from a multicenter prospective study.

scholarly journals Fournier’s Gangrene: Current Practices

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
M. N. Mallikarjuna ◽  
Abhishek Vijayakumar ◽  
Vijayraj S. Patil ◽  
B. S. Shivswamy
Keyword(s):  
Necrotizing Fasciitis ◽  
External Genitalia ◽  
Severity Index ◽  
Fournier’S Gangrene ◽  
Risk Category ◽  
Urethral Reconstruction ◽  
Risk Indicator ◽  
Fournier's Gangrene ◽  
Fournier Gangrene ◽  
Severity Index Score

Fournier’s gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20–30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes.

scholarly journals Scrotal reconstruction with pedicled gracilis muscle flap following Fournier’s gangrene: a case report and literature review

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Oluwatosin Stephen Ilori ◽  
David. A. Onilede ◽  
Ademola. A. Popoola ◽  
Olorunnisola O. Olatide ◽  
Chidi O. Ugwuoke
Keyword(s):  
Donor Site ◽  
Outlet Obstruction ◽  
Muscle Flap ◽  
External Genitalia ◽  
Donor Site Morbidity ◽  
Fournier’S Gangrene ◽  
Gracilis Muscle ◽  
Fournier's Gangrene ◽  
Additional Advantage ◽  
Gracilis Muscle Flap

Abstract Background Fournier’s gangrene is an acute soft tissue necrotizing infection involving the perineum and the external genitalia which can result in a major loss of the scrotal wall with exposure of the testicles. Reconstruction of such major defect is quite challenging; the use of pedicled gracilis muscle flap helps to create an aesthetically acceptable scrotum with minimal donor site morbidity. Case presentation We described the case of a 60-year-old man with a large scrotal loss from Fournier’s gangrene following bladder outlet obstruction and perineal abscess. He had multiple debridement and reconstruction with pedicled left gracilis muscle flap with a good aesthetic and functional post-operative outcome. The major challenge encountered was the loss of the skin graft as a result of the retraction of the muscle flap due to too early ambulation; this can thus be avoided by adequate pre-operative counseling and enforcing bed rest. Conclusions The use of gracilis muscle flap in the reconstruction of large scrotal defect described in this report has the additional advantage of creating a pliable and soft feel like that of the original scrotum with minimal donor site morbidity.

scholarly journals New Methods of Reconstruction for Old Challenges: The Use of the Integra Graft in Necrotizing Soft Tissue Infections of the Male Genitalia

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Katharina Mitchell ◽  
Chad Crigger ◽  
Chad Morley ◽  
John Barnard ◽  
Vidas Dumasius
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
External Genitalia ◽  
Skin Grafting ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Bovine Collagen ◽  
Necrotizing Soft Tissue Infections ◽  
Perineal Region ◽  
Methods Of Reconstruction

In this paper, we describe two cases of Fournier’s gangrene (FG) in which Integra grafting was used for reconstruction. FG is a progressive necrotizing infection occurring in the perineal region and on the external genitalia. Reconstructive options using local tissue are limited due to the destruction this infection imposes on the soft tissue. Integra graft is a bilaminate artificial dermis made of shark chondroitin 6-sulfate and bovine collagen. It is applied to the wound bed after debridement and establishment of a healthy, well-vascularized wound base. The patients in this case series had large defects which could not be closed primarily with tissue beds and would not have been appropriate for skin grafting. Therefore, an Integra graft was placed. In both patients, the wound beds were appropriate for skin grafting after three weeks. Without the Integra graft, both of our patients would have needed to wait a considerable amount of time prior to reconstruction. Our case series further illustrates and supports the use of Integra grafts in such a scenario following Fournier’s gangrene which has only previously been published on three occasions, all of which demonstrated successful outcomes.

scholarly journals Retroperitoneal Spread of Fournier's Gangrene: A Rare but Fatal Presentation

2016 ◽  
Vol 5 (3) ◽  
pp. 166-168
Author(s):  
Apoorv Goel ◽  
Roli Bansal
Keyword(s):  
Septic Shock ◽  
Necrotizing Fasciitis ◽  
Multiorgan Failure ◽  
Psoas Muscle ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Elderly Males ◽  
Scrotal Edema ◽  
Lower Abdominal Wall

ABSTRACT Fournier's gangrene is severe infective necrotizing fasciitis of the external genitalia predominantly in elderly males. It is usually associated with septic shock and multiorgan failure. A 55-yearold male presented with scrotal edema, pain, and redness over lower abdominal wall and both flanks with features of sepsis and ileus. Intraoperative findings were suggestive of extensive necrotizing fasciitis of scrotum spreading to both inguinal region, right lateral parietal wall, and right psoas muscle. How to cite this article Goel A, Bansal R. Retroperitoneal Spread of Fournier's Gangrene: A Rare but Fatal Presentation. Panam J Trauma Crit Care Emerg Surg 2016;5(3):166-168.

scholarly journals A clinical study of management of Fournier’s gangrene in a rural hospital

2018 ◽  
Vol 5 (4) ◽  
pp. 1524
Author(s):  
Purushotham T. Shivaraju ◽  
Ponnappa B. Ganapathy ◽  
Naveen N. ◽  
Pruthvika N.
Keyword(s):  
Soft Tissue ◽  
Hospital Stay ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
Surgical Reconstruction ◽  
Reconstructive Procedure ◽  
Soft Tissue Defects ◽  
Fournier's Gangrene ◽  
Wound Debridement ◽  
Tissue Defects

Background: Fournier’s gangrene is a potentially life threatening synergistic necrotising fascitis of external genitalia and perineal tissues. It commonly affects young men but can also affect women and children. The use of broad spectrum antibiotics and serial wound debridement is the main stay of treatment. The reconstruction of soft tissue defect following the debridement is a challenging task. The purpose of this study is to evaluate the surgical reconstruction methods of soft tissue defects due to Fournier's gangrene.Methods: This was a prospective study conducted in Adichunchanagiri Institute of Medical Sciences from January 2015 to December 2017. All patients with necrotizing fascitis of external genitalia and perineum, irrespective of age and gender, were included. Parameters such as age, gender, aetiology, predisposing factors, clinical features, defect location, type of bacterial flora, sort of reconstructive procedure used, and duration of hospital stay, post-operative pain, patient satisfaction and mortality, if any, were studied. The choice of reconstructive procedure was based on severity of defect, availability of local tissue and patient preference.Results: Out of 31 cases included in the study, 30 patients underwent reconstructive procedures. The age range was 4 to 74 years (mean 38.5). The commonest presentation was pain, scrotal swelling and fever. The most common aetiology was urogenital diseases. 10 patients were treated by split-thickness skin graft, 5 by secondary suturing, 2 by unilateral superomedial thigh flap, 4 by bilateral superomedial thigh flap, 5 by tensor fascia lata flap, 2 by medial thigh V-Y advancement flap, 2 with perineal artery flap and one case healed by secondary intention.Conclusions: This study suggests that earlier presentation, with early diagnosis and intervention with prompt debridement and appropriate, appropriate antibiotics are the main stays of treatment. The resulting soft tissue defects following wound debridement required surgical reconstruction, except in one case, thus decreasing morbidity, hospital stay and early return of patients to regular life.

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