FOURNIER’S GANGRENE THE APPROACH SHOULD BE BLOODY, BOLD AND RESOLUTE

Objective: To determine the role of aggressive surgical debridement on the mortality and morbidity associated with
Fournier’s gangrene.
Study design: This is a retrospective study.
Place and Duration: Surgical Department of Khyber Teaching Hospital, Peshawar from June 2007 to June 2011.
Patients and Methods: During the four years duration of this study an overall 37 cases with Fournier’s gangrene were
studied. All of them underwent extensive surgical debridement in operation theatre along with minor debridements and
dressings in ward. The patient’s age, the site, extent and origin of the ulcers were documented. The patient’s social
class, nutritional status, associated illness and constitutional disturbance were also investigated. Blood was taken for
fasting sugar, hemoglobin, white cell total and differential counts. Broad spectrum antibiotics were started immediately.
Results: The mean age of presentation was 41.2 (33-72 years). Most patients presented with prodromal symptoms
of fever and lethargy, which was present for 2-7 days with increasing genital pain and tenderness and edema 12 patients
presented with obvious gangrene of a portion of the genitalia with purulent drainage from wounds. Aggressive
surgical debridement was done in all cases. 23 patients were operated within 24 hours of admission and 5 patients
were operated within 3 to 4 days, in 7 patients the delay was due to patients seeking late help from hospital. Broad
spectrum antibiotics were started immediately which were changed according to C/S report within 24-48 hours. The
mortality was 16 out of 37.
Conclusion: Fournier’s gangrene is a very lethal disease even under optimal conditions and the best approach towards
it is aggressive surgical debridement with proper antibiotics and nutritional support.