Hyperbaric oxygen in the treatment of Fournier's gangrene

Objective: To investigate the efficacy of operation, antibiotic treatment, hyperbaric oxygen, and surgical intensive care in the management of Fournie r's gangrene. Design: Retrospective study. Setting: University hospital, Finland. Subjects: 33 patients, most of them referred from other hospitals. Intervention: Debridement, broad spectrum antibiotics, and hyperbaric oxyge n (HBO) treatment at 2.5 atmospheres absolute pressure. Excision of necroti c tissue and incisions in the affected areas. Urinary and faecal diversions when necessary. Main outcome measures: Morbidity and mortality. Results: Only three patients died (9%). Hyperbaric oxygen reduced systemic toxicity, prevented extension of the necrotising infection, and increased d emarcation, thereby improving the overall outcome. Conclusion: To reduce mortality and morbidity, effective treatment of Fourn ier's gangrene should be started promptly. Debridement and antibiotics comb ined with surgical intensive care must be started as soon as possible. Hype rbaric oxygen is both life and tissue saving. It is an important adjunct th at prevents extension of necrosis and reduces systemic toxicity.