SURGICAL-TREATMENT OF FOURNIERS GANGRENE

Acute perineal gangrene due to anaerobic Gram negative bacilli or stre ptococci rapidly leads to tissue necrosis and death in 50% of the case s despite progress in intensive care. Emergency treatment requires ada pted antibiotics, hyperbaric oxygen therapy and repeated surgery. Fact ors of poor prognosis include age over 60 years, lomboabdominal or cru ral extension, septic shock, positive blood cultures and lack of fecal derivation. Surgery is performed under general anaesthesia since loco -regional anaesthesia is contraindicated during the septic phase. Repe ated operations are needed to make large incisions, evacuate pus, sear ch for foreign bodies and resect damaged tissue in order to expose all the infected areas to air and hyperbaric oxygen. A colostomy must be performed in order to avoid fistulization and contamination of the inf ected areas, An indwelling urine catheter is usually sufficient althou th a suprapubic catheter may be needed at the risk of further extensio n of the gangrene. Surgical treatment is associated with intensive car e and hyperbaric oxygen therapy. Three effective antibiotics are recom mended. Using this aggressive surgical protocol, we have been able to reduce mortality to 20% in patients under 60 years of age.