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A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers
Official Journal of the Italian Association for Cutaneous Ulcers
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Acta Vulnologica 2013 December;11(4):161-70
language: English, Italian
Fournier’s gangrene: treatment algorithm for a complex wound
Scalise A. 1, Tartaglione C. 2, Bottoni M. 2, Torresetti M. 2, Gioacchini M. 3, Pierangeli M. 2, Grassetti L. 1, Di Benedetto G. 1
1 Department of Experimental Medicine and Clinic Plastic Surgery and Reconstruction Clinic Marche Polytechnic University, Ancona, Italy;
2 Ospedali Riniti, Ancona, Italy;
3 Ancona University Hospital Torrette, Ancona, Italy
Aim: Fournier’s syndrome is an acute expansive bacterial infection which necrotizes the soft parts of the perineum, the scrotum and the lower part of the trunk and is a serious disease which should be tackled in its early stages. The purpose of this article is to show our experience suggesting a treatment algorithm which integrates surgical therapy and advanced conservative procedures.
Methods: The clinical-instrumental data of patients suffering from Fournier’s Syndrome and who have been treated by the Plastic Surgery and Reconstruction Clinic of the United Hospitals of Ancona over the course of six years have been analyzed.
Results: We analyzed 15 cases, 13 men and 2 women. At the diagnosis stage the average age of the patients was 59.5 years and the Fournier’s Gangrene Severity Index was 3.5. All the patients proved positive to the cultural exam with poly-microbial flora. Fourteen out of the 15 patients underwent hyperbaric oxygen therapy (HBOT) sessions. All were submitted to early surgical debridement and advanced dressings. In 2 cases negative pressure therapy was used. In 5 cases it was necessary to perform reconstructive surgery.
Conclusion: Fournier’s syndrome requires immediate treatment and the choice of the most suitable strategy depends on the Severity index of the disease and the patient’s overall clinical conditions. We propose a treatment algorithm which is able to correctly manage this disease. Primary surgery and periodic advanced dressings should always be implemented and are often sufficient to achieve full healing; in particularly severe cases reconstructive surgery remains the only therapeutic strategy available