THE LIMITED IMPACT OF INVOLVED SURFACE-AREA AND SURGICAL DEBRIDEMENT ON SURVIVAL IN FOURNIERS GANGRENE

Objective To evaluate the influence of involved surface area (extent o f disease) and the number and timing of surgical debridements on survi val in patients with Fournier's gangrene, Patients and methods The med ical records of 30 patients with Fournier's gangrene treated over a 15 -year period were reviewed. The extent of disease was quantified and e xpressed as a percentage of the body surface area by applying a modifi ed diagram used to assess burn injuries, The number of surgical debrid ements and their timing with respect to initial presentation and to ea ch other were also analysed. Patients were stratified by outcome (surv ival or death) and the data evaluated by Student's t-test, Fisher's ex act test and regression analysis. Results Of 30 patients treated 13 di ed (43%) and 17 survived (57%). The mean surface area involved by dise ase among survivors was 4.3% (range 1-16.5%) and 7.2% (range 5-20.5%) for non-survivors (P=0.10). Whilst no direct correlation between death rate and extent of disease existed, patients with < 5% surface area i nvolvement were more likely to survive. (P=0.014). Every patient under went surgical debridement of the involved area (mean 1.72 procedures p er patient). Survivors underwent from one to four debridements (mean 1 .79) and non-survivors one to three debridements (mean 1.63); the mean number of debridements did not influence outcome (P=0.68), The perfor mance of more than one debridement did not affect survival (P=1.00), T he initial debridement was performed within 24 h of presentation in 10 of 13 patients who died and 11 of 17 survivors and had no effect on o utcome (P=0.69). A second debridement was performed after a mean of 6. 8 days (range 1-12) among the six survivors and 5.4 days (range 2-16) among the five non-survivors; this difference was not statistically si gnificant (P=0.65), Four survivors required a third debridement, one r equired a fourth and one patient who succumbed underwent a third debri dement. Conclusion The mortality rate from Fournier's gangrene continu es to be substantial (43% in our series). Although no linear correlati on existed, the quantified extent of disease may affect outcome as pat ients with > 5% of body surface area involved were more likely to succ umb to the disease. Finally, the number of surgical debridements, even if first performed within 24 h of presentation, had no impact on outc ome in patients with Fournier's gangrene.