A new bacteriologic approach to perineal gangrene. Results of medico-surgical management. Report of 81 cases.

Study objective: The objective of this retrospective study was to report th e results of a series of 81 cases of perineal gangrene treated in the same center. Patients and methods: From 1988 to 1998, 81 patients (64 males, 17 females, mean age: 58 years) with perineal gangrene were treated by a medico-surgic al team, by means of a protocol combining appropriate intensive care measur es based on a new bacteriologic concept of infectious agents, extensive exc isions and drainage of the infraperitoneal region and hyperbaric oxygen the rapy. Results: The mortality rate was 24.7%. Mean duration of intensive care stay was 19 days, mean duration of hospital stay was 31 +/- 4 days (range: 6 to 60 days). Risk factors were: age > 68 years (p = 0.001), shock (p = 0.83), subcutaneous crepitation (p = 0.25) and severity index > 10 (p = 0.003). S equelae were anal incontinence (n = 3) and permanent colostomy (n = 5). Sec ondary plastic reconstruction was necessary in four patients. There were no urologic or genital sequelae. Conclusion: Perineal gangrene is still a very serious disease. The time to treatment, the simplified severity index and consideration of bacteriologic combinations are the main prognostic factors. (C) 2000 Editions scientifiq ues et medicales Elsevier SAS.