eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Fournier Gangrene: Follow-up

Author: Thomas Santora, MD, Professor and Vice-Chair for Clinical Affairs, Department of Surgery, Temple University Hospital and School of Medicine
Coauthor(s): Daniel B Rukstalis, MD, Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group
Contributor Information and Disclosures

Updated: Mar 19, 2009

Outcome and Prognosis

To date, all studies of Fournier gangrene have been in the form of clinical series reviewed retrospectively.37,38 Therefore, drawing reliable prognostic information from these studies is scientifically unsound. Given that proviso, Laor and colleagues introduced the Fournier Gangrene Severity Index (FGSI) based on deviation from reference ranges of 9 clinical parameters (temperature, heart rate, respiratory rate, white blood cell count, and levels of sodium, potassium, creatinine, hematocrit, sodium bicarbonate). Each parameter was valued between 0 and 4, with the higher value assigned to the greatest deviation from normal. The FGSI represents the sum of all the parameters values. They determined that advanced age (not a factor in the FGSI) and a FGSI greater than 9 correlated with increased mortality.39 Corcoran et al validated the FGSI in a retrospective review of 68 patients.40

In summary, the mortality risk may be directly proportional to the age of the patient and the extent of systemic toxicity upon admission (FGSI), as well as to the extent of the local tissue involvement.41

In some studies, Fournier disease that originates from diseases of the anorectum carries a worse prognosis than cases caused by other factors. In the 600 cases of Fournier gangrene discovered during a Medline search dating back to 1996, 100 deaths occurred (16.5%). In the series that included more than 20 patients, the mortality rate ranged from 4-54%, with most studies reporting mortality rates of 20-30%.42,43

The prognosis of Fournier disease following reconstruction is usually good. Approximately 50% of men with penile involvement have pain upon arousal. This pain is often related to limited mobility of the genitalia due to scarring. Consultation with a psychiatrist may be beneficial in some patients in order to deal with the emotional stress of an altered body image. If extensive soft tissue is lost, lymphatic drainage may be impaired; thus, dependent edema and cellulitis may result. Use of external support may be beneficial to minimize this postoperative problem.

Future and Controversies

The role of hyperbaric oxygen therapy in the treatment of Fournier disease needs to be clarified with a prospective controlled trial.44

The role of topical agents in wound care also requires further investigation. Although reports from Africa extol the beneficial chemical effects of unprocessed honey, the salutatory effect of honey is likely related to its physical property of hyperosmolarity.45 Therefore, honey holds little advantage over other hygroscopic agents.46 The application of growth hormones and other trophic agents holds the potential to promote faster wound healing. The use of vacuum dressing technologies to hasten the wound closure has only recently been used to treat these wounds.

 


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References
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References

  1. Wilson B. Necrotizing fasciitis. Am Surg. Apr 1952;18(4):416-31. [Medline].

  2. Corman JM. Classic articles in colonic and rectal surgery. Dis Colon Rectum. 1988;31:984-8.

  3. Ekelius L, Björkman H, Kalin M, Fohlman J. Fournier's gangrene after genital piercing. Scand J Infect Dis. 2004;36(8):610-2. [Medline].

  4. Paty R, Smith AD. Gangrene and Fournier's gangrene. Urol Clin North Am. Feb 1992;19(1):149-62. [Medline].

  5. Ayumba BR, Magoha GA. Epidemiological aspects of Fournier's gangrene at Kenyatta National Hospital, Nairobi. East Afr Med J. Oct 1998;75(10):586-9. [Medline].

  6. Ayumba BR, Magoha GA. Management of Fournier's gangrene at the Kenyatta National Hospital, Nairobi. East Afr Med J. Jun 1998;75(6):370-3. [Medline].

  7. Smith GL, Bunker CB, Dinneen MD. Fournier's gangrene. Br J Urol. Mar 1998;81(3):347-55. [Medline].

  8. Clayton MD, Fowler JE Jr, Sharifi R, Pearl RK. Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia. Surg Gynecol Obstet. Jan 1990;170(1):49-55. [Medline].

  9. Gamagami RA, Mostafavi M, Gamagami A, Lazorthes F. Fournier's gangrene: an unusual presentation for rectal carcinoma. Am J Gastroenterol. Apr 1998;93(4):657-8. [Medline].

  10. Gould SW, Banwell P, Glazer G. Perforated colonic carcinoma presenting as epididymo-orchitis and Fournier's gangrene. Eur J Surg Oncol. Aug 1997;23(4):367-8. [Medline].

  11. Brings HA, Matthews R, Brinkman J, Rotolo J. Crohn's disease presenting with Fournier's gangrene and enterovesical fistula. Am Surg. May 1997;63(5):401-5. [Medline].

  12. Mouraviev VB, Pautler SE, Hayman WP. Fournier's gangrene following penile self-injection with cocaine. Scand J Urol Nephrol. 2002;36(4):317-8. [Medline].

  13. Faber HJ, Girbes AR, Daenen S. Fournier's gangrene as first presentation of promyelocytic leukemia. Leuk Res. May 1998;22(5):473-6. [Medline].

  14. Martinelli G, Alessandrino EP, Bernasconi P, et al. Fournier's gangrene: a clinical presentation of necrotizing fasciitis after bone marrow transplantation. Bone Marrow Transplant. Nov 1998;22(10):1023-6. [Medline].

  15. Kohagura K, Sesoko S, Tozawa M, et al. [A female case of Fournier's gangrene in a patient with lupus nephritis]. Nippon Jinzo Gakkai Shi. Jul 1998;40(5):354-8. [Medline].

  16. Roca B, Cuñat E, Simón E. HIV infection presenting with Fournier's gangrene. Neth J Med. Oct 1998;53(4):168-71. [Medline].

  17. Rajbhandari SM, Wilson RM. Unusual infections in diabetes. Diabetes Res Clin Pract. Feb 1998;39(2):123-8. [Medline].

  18. Mergenhagen SE, Thonard JC, Scherp HW. Studies on synergistic infections. I. Experimental infections with anaerobic streptococci. J Infect Dis. Jul-Aug 1958;103(1):33-44. [Medline].

  19. Meleney FL. Hemolytic Streptococcus gangrene. Arch Surg. 1924;9:317-21.

  20. Moses AE. Necrotizing fasciitis: flesh-eating microbes. Isr J Med Sci. Sep 1996;32(9):781-4. [Medline].

  21. Benizri E, Fabiani P, Migliori G, et al. Gangrene of the perineum. Urology. Jun 1996;47(6):935-9. [Medline].

  22. Benchekroun A, Lachkar A, Bjijou Y, et al. [Gangrene of the external genital organs. Apropos of 55 cases]. J Urol (Paris). 1997;103(1-2):27-31. [Medline].

  23. Ben-Aharon U, Borenstein A, Eisenkraft S, et al. Extensive necrotizing soft tissue infection of the perineum. Isr J Med Sci. Sep 1996;32(9):745-9. [Medline].

  24. Basoglu M, Gül O, Yildirgan I, Balik AA, Ozbey I, Oren D. Fournier's gangrene: review of fifteen cases. Am Surg. Nov 1997;63(11):1019-21. [Medline].

  25. Goyette M. Group A streptococcal necrotizing fasciitis Fournier's gangrene--Quebec. Can Commun Dis Rep. Jul 1 1997;23(13):101-3. [Medline].

  26. Fan CM, Whitman GJ, Chew FS. Radiologic-Pathologic Conferences of the Massachusetts General Hospital. Necrotizing fasciitis of the scrotum (Fournier's gangrene). AJR Am J Roentgenol. May 1996;166(5):1164. [Medline].

  27. Rajan DK, Scharer KA. Radiology of Fournier's gangrene. AJR Am J Roentgenol. Jan 1998;170(1):163-8. [Medline].

  28. Kane CJ, Nash P, McAninch JW. Ultrasonographic appearance of necrotizing gangrene: aid in early diagnosis. Urology. Jul 1996;48(1):142-4. [Medline].

  29. Sherman J, Solliday M, Paraiso E, Becker J, Mydlo JH. Early CT findings of Fournier's gangrene in a healthy male. Clin Imaging. Nov-Dec 1998;22(6):425-7. [Medline].

  30. Wysoki MG, Santora TA, Shah RM, Friedman AC. Necrotizing fasciitis: CT characteristics. Radiology. Jun 1997;203(3):859-63. [Medline].

  31. Stevens DL, Gibbons AE, Bergstrom R, Winn V. The Eagle effect revisited: efficacy of clindamycin, erythromycin, and penicillin in the treatment of streptococcal myositis. J Infect Dis. Jul 1988;158(1):23-8. [Medline].

  32. Cawley MJ, Briggs M, Haith LR Jr, Reilly KJ, Guilday RE, Braxton GR. Intravenous immunoglobulin as adjunctive treatment for streptococcal toxic shock syndrome associated with necrotizing fasciitis: case report and review. Pharmacotherapy. Sep 1999;19(9):1094-8. [Medline].

  33. Korhonen K, Hirn M, Niinikoski J. Hyperbaric oxygen in the treatment of Fournier's gangrene. Eur J Surg. Apr 1998;164(4):251-5. [Medline].

  34. Pizzorno R, Bonini F, Donelli A, Stubinski R, Medica M, Carmignani G. Hyperbaric oxygen therapy in the treatment of Fournier's disease in 11 male patients. J Urol. Sep 1997;158(3 Pt 1):837-40. [Medline].

  35. Hollabaugh RS Jr, Dmochowski RR, Hickerson WL, Cox CE. Fournier's gangrene: therapeutic impact of hyperbaric oxygen. Plast Reconstr Surg. Jan 1998;101(1):94-100. [Medline].

  36. Kovacs LH, Kloeppel M, Papadopulos NA, Reeker W, Biemer E. Necrotizing fasciitis. Ann Plast Surg. Dec 2001;47(6):680-2. [Medline].

  37. Corman JM, Moody JA, Aronson WJ. Fournier's gangrene in a modern surgical setting: improved survival with aggressive management. BJU Int. Jul 1999;84(1):85-8. [Medline].

  38. Chen CS, Liu KL, Chen HW, Chou CC, Chuang CK, Chu SH. Prognostic factors and strategy of treatment in Fournier's gangrene: a 12-year retrospective study. Changgeng Yi Xue Za Zhi. Mar 1999;22(1):31-6. [Medline].

  39. Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier's gangrene. J Urol. Jul 1995;154(1):89-92. [Medline].

  40. Corcoran AT, Smaldone MC, Gibbons EP, Walsh TJ, Davies BJ. Validation of the Fournier's gangrene severity index in a large contemporary series. J Urol. Sep 2008;180(3):944-8. [Medline].

  41. Norton KS, Johnson LW, Perry T, et al. Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment. Am Surg. Aug 2002;68(8):709-13. [Medline].

  42. Papachristodoulou AJ, Zografos GN, Papastratis G, Papavassiliou V, Markopoulos CJ, Mandrekas D, et al. Fournier's gangrene: still highly lethal. Langenbecks Arch Chir. 1997;382(1):15-8. [Medline].

  43. Hejase MJ, Simonin JE, Bihrle R, Coogan CL. Genital Fournier's gangrene: experience with 38 patients. Urology. May 1996;47(5):734-9. [Medline].

  44. Mindrup SR, Kealey GP, Fallon B. Hyperbaric oxygen for the treatment of fournier's gangrene. J Urol. Jun 2005;173(6):1975-7. [Medline].

  45. Nomikos IN. Necrotizing perineal infections (Fournier's disease): old remedies for an old disease. Int J Colorectal Dis. 1998;13(1):48-51. [Medline].

  46. Asci R, Sarikaya S, Büyükalpelli R, Yilmaz AF, Yildiz S. Fournier's gangrene: risk assessment and enzymatic debridement with lyophilized collagenase application. Eur Urol. 1998;34(5):411-8. [Medline].

  47. el Khader K, el Fassi J, Nouri M, Ibn Attya A, Hachimi M, Lakrissa A. [Fournier's gangrene. Analysis of 32 cases]. J Urol (Paris). 1997;103(1-2):32-4. [Medline].

  48. Kovacs LH, Kloeppel M, Papadopulos NA, et al. Necrotizing fasciitis. Ann Plast Surg. Dec 2001;47(6):680-2.

  49. Loulergue P, Mahe V, Bougnoux ME, Poiree S, Hot A, Lortholary O. Fournier's gangrene due to Candida glabrata. Med Mycol. Mar 2008;46(2):171-3. [Medline].

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Further Reading

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Keywords

Fournier gangrene, Fournier's gangrene, genital gangrene, penile gangrene, idiopathic gangrene of the penis and scrotum, spontaneous fulminant gangrene of the scrotum, necrotizing fasciitis of the scrotum, necrotizing fasciitis of the male genitalia, infectious gangrene of the scrotum and penis, scrotal gangrene, synergistic gangrene of the male genitalia, gangrenous erysipelas of the scrotum, streptococcal gangrene of the scrotum, necrotizing fasciitis, genital necrotizing fasciitis, scrotal necrotizing fasciitis, penile necrotizing fasciitis, testicular necrotizing fasciitis, Fournier’s disease, Fournier disease

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Contributor Information and Disclosures

Author

Thomas Santora, MD, Professor and Vice-Chair for Clinical Affairs, Department of Surgery, Temple University Hospital and School of Medicine
Thomas Santora, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Trauma Society, Association for Academic Surgery, and Eastern Association for the Surgery of Trauma
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel B Rukstalis, MD, Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group
Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Alex Jacocks, MD, Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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