FOURNIERS-GANGRENE - RISK ASSESSMENT AND ENZYMATIC DEBRIDEMENT WITH LYOPHILIZED COLLAGENASE APPLICATION

Objectives: Fournier's gangrene (FG) is an abrupt, rapidly progressive , gangrenous infection of the external genitalia, perineum or abdomina l wall and is a real urologic emergency. In this study, the risk facto rs of FG and the effects of enzymatic debridements on wound healing we re investigated. Patients and Methods: We reviewed the records of 34 p atients with FG to investigate the possible correlation between clinic al outcome and infection focus, patient age, number of types of bacter ia cultured, delay until presentation, predisposing diseases or accomp anying conditions such as diabetes, neurologic deficit, chronic alcoho lism and renal failure. Broad-spectrum triple antimicrobial therapy, a ggressive and frequent surgical debridement, and if necessary urinary and colonic diversions were performed to control the infection. The ef fects of enzymatic debridements with topical lyophilized collagenase a pplications on the wound healing after the control of active infection were evaluated. Results: The average age of the patients was 55 years . The sources of infections were urogenital in 12 (35.3%), anorectal i n 10 (29.4%), dermal in 10 (29.4%) and undetermined in 2 (5.8%) of the patients. The average presentation time was 4.4 days and the number o f isolated bacteria was 3.05 per case. The number of isolated bacteria and surgical debridements, the duration of hospital stay and the rate of mortality in patients with anorectal foci were higher than those o f the patients with urogenital or dermal foci (p < 0.05). Diabetes, ur emia and advanced age did not significantly affect the number of surgi cal debridements, the duration of hospital stay and control of active infection. Mortality was increased in chronic alcoholism, a finding of undetermined significance. Enzymatic debridements decreased the durat ion of hospital stay (p < 0.05). Five patients (14.7%) died despite pr ompt medical and surgical preventive measures. Conclusion: Chronic alc oholism, anorectal infection foci, neurological deficit and delayed pr esentation were found as risk factors in FG. Diabetes and advanced age did not affect the progression of disease in our cases. Enzymatic deb ridements decrease the number of surgical debridements and the duratio n of hospital stay.