Experiencia y revisión de la literatura en el manejo de gangrena de Fournier en una institución, 2008-2015

Abstract

Background

Fournier's gangrene is characterized by necrosis and gangrene of the subcutaneous tissue, superficial and deep fascia, and muscles in the perineum and genitals. The risk factors are: alcoholism, diabetes, malnutrition, advanced age, and immunosuppression. Treatment is based on broad-spectrum antibiotics and radical surgical debridement.

Aim

To report our institutional experience in the treatment of Fournier's gangrene.

Material and Methods

A retrospective, analytic study was conducted that included 46 patients attended to within the time frame of 2008-2015.

Results

Low socioeconomic level was the most frequent factor (61.4%), followed by diabetes (52.3%). Multiple surgeries were required in 79.5% of the cases and the mortality rate was 6.8%. A total of 68.3% of the cases had a urologic origin, followed by soft tissue involvement (27.3%), and the most frequent microorganism was Escherichia coli (61.4%).

Discussion

Treatment included broad-spectrum antibiotics (carbapenems) and radical surgical treatment; vacuum-assisted closure was recommended. Once a negative culture was obtained, rehabilitation and reconstruction were carried out to optimize the functional capacity of the patients. In our population, economic limitations and treatment abandonment limited the described management.

Conclusions

Fournier's gangrene presents with a critical mortality rate. Initial aggressive antibiotic and surgical treatment improves survival and later rehabilitation and reconstruction improve functional capacity.