FOURNIERS-GANGRENE - THERAPEUTIC IMPACT OF HYPERBARIC-OXYGEN

Many controversial issues exist surrounding the disease pathogenesis a nd optimal, management of Fournier's gangrene. In Fournier's original descriptions, the disease arose in healthy subjects without an obvious cause. Most contemporary studies, however, are able to identify defin ite urologic or colorectal etiologies in a majority of cases. To inves tigate disease presentation, treatment modalities, and overall mortali ty, a retrospective analysis of Fournier's gangrene from a single inst itution is presented. Since 1990, 26 cases of Fournier's gangrene have been diagnosed at the University of Tennessee. An evaluation of inter current disease revealed that 38 percent of the patients had diabetes mellitus, 35 percent manifested ethanol abuse, and 12 percent were sys temically immunosuppressed. Fifteen patients (58 percent) presented wi th identifiable etiologies for their disease: 31 percent (8) urethral disease or trauma, 19 percent (5) colorectal disease, and 8 percent (2 ) penile prostheses. Management in all cases involved prompt surgical debridement with initiation of broad-spectrum antibiotics. Multiple de bridements, orchiectomy, urinary diversion, and fecal diversion were p erformed as clinically indicated. Fourteen patients received hyperbari c oxygen as adjuvant therapy. Statistically significant results were n oted with mortality rates of 7 percent in the group receiving hyperbar ic oxygen (n = 14) versus 42 percent in the group not receiving hyperb aric oxygen (n = 12). Overall mortality was 23 percent. Controversy st ill surrounds disease pathogenesis in Fournier's gangrene, particularl y in regard to etiology. Our study corroborates current trends in that a clear focus of origin was identified in a majority of the cases. Al though a grim prognosis usually accompanies the diagnosis, this study shows significant improvement combining traditional surgical and antib iotic regimens with hyperbaric oxygen therapy.