NDLI: Fournier's gangrene: management at a regional burn center.

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Fournier's gangrene: management at a regional burn center.

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Fournier's gangrene: management at a regional burn center.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Saffle, Jeffrey R. Morris, Stephen E. Edelman, Linda
Description	Country affiliation: United States Author Affiliation: Saffle JR ( Department of Surgery, Burn-Trauma Center, University of Utah Health Center, Salt Lake City, Utah 84132, USA.)
Abstract	Fournier's gangrene (FG) describes necrotizing infections of the perineum in both sexes. Controversies in treatment of FG include the roles of orchiectomy, urinary and/or fecal diversion, and hyperbaric oxygen (HBO). Because burn centers often treat these patients, we reviewed our experience with FG during a 14-year period. With Institutional Review Board approval, we reviewed our TRACS/ABA database for patients treated for FG during 1992 to 2005. Data was recorded on demographics, preexisting medical conditions, treatment, and outcomes. Thirty patients (20 men) were identified. Mean age was 54.3 +/- 14.1 years. Predisposing conditions included diabetes in 16 patients (53%), and morbid obesity and immunosuppression in 6 each. Twenty-two patients were transferred from outside hospitals, 12 after initial surgery. Sixteen patients presented with shock (blood pressure <90/60 mm Hg). Patients underwent a mean of 4.1 surgical procedures. Ten infections penetrated the deep fascia of the perineum or abdominal wall. Suprapubic cystostomy was performed in three patients, colostomy in seven, orchiectomy in one. HBO was not used. Hospitalization averaged 25.3 +/- 15.6 days. Mean charges (\$1000) were \$131.5 +/- 108.3. Definitive wound closure was obtained before discharge with suture repair and/or skin grafting in 18 of 25 survivors (72%). Five patients died (17%). In logistic regression analysis, the presence of shock on admission and female gender (mortality 40%) were significantly associated with mortality. FG remains a devastating infection, which occurs primarily in compromised patients. In this series, aggressive burn center care produced outcomes equivalent to those published in other series with or without use of HBO. Colostomy and urinary diversion can be used very selectively in these patients; orchiectomy is rarely required.
File Format	HTM / HTML
ISSN	1559047X
Issue Number	1
Volume Number	29
e-ISSN	15590488
Journal	Journal of Burn Care & Research
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2008-01-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Traumatology Burn Units Burns Complications Fournier Gangrene Etiology Treatment Outcome Adult Aged Mortality Physiopathology Critical Illness Diabetes Mellitus Female Humans Immunocompromised Host Male Middle Aged Obesity Patient Care Team Retrospective Studies Risk Factors Journal Article
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine Rehabilitation Surgery

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