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Kumar SS, Sun HH, Tay K, Sellke N, Bodner D, Gupta S, Mishra K, Scarberry K. Favorable Safety Outcomes of Delayed Primary Closure of Large Fournier's Gangrene Skin Defects. Urology 2023; 180:270-277. [PMID: 37544517 DOI: 10.1016/j.urology.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To assess the feasibility and safety of delayed primary closure (DPC) in Fournier's gangrene (FG) patients with large genital defects. METHODS A single institution retrospective review was performed from October 2020 to December 2022 of adult males that underwent DPC for FG. All patients underwent standard medical management and were assessed for DPC eligibility by the urology service. Clinical data on patient factors and outcomes were collected, and descriptive statistics were assessed. RESULTS Of 16 patients that underwent DPC, the average age was 61.1years and body mass index was 34.6 kg/m2. Median Charlson Comorbidity Index was 3.5 (IQR 2-5.3) and Fournier's Gangrene Severity Index was 6.5 (IQR 4.8-8). Median number of debridements was 2.5 (IQR 2-3), with a time to closure of 6.5days (IQR 3-11) and length of stay of 13days (IQR 9-16.3). Mean genital defect size was 119 cm2 (range 44-346 cm2). Eight patients (50%) were closed using scrotal flaps alone while other patients had advancement flaps using the inner thigh, lower abdomen, and perineum. The majority of patients were discharged home directly (63%). There were four Clavien-Dindo III complications: two partial flap necrosis, one wound dehiscence, and one instance of bleeding. Of patients with follow-up, 6/15 (40.0%) had no known complications. CONCLUSION DPC is safe and effective for a range of patients presenting with FG. Patients with large defects may benefit from less complex wound management and direct discharge home.
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Affiliation(s)
| | - Helen H Sun
- Case Western Reserve University School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH.
| | - Kimberly Tay
- Case Western Reserve University School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Nicholas Sellke
- Case Western Reserve University School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Donald Bodner
- Case Western Reserve University School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Shubham Gupta
- Case Western Reserve University School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Kirtishri Mishra
- Case Western Reserve University School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Kyle Scarberry
- Case Western Reserve University School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
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Tufano A, Dipinto P, Passaro F, Anceschi U, Franco G, Flammia RS, Proietti F, Antonelli L, Di Pierro GB, Prata F, Rullo R, Perdonà S, Leonardo C. The Value of Fournier's Gangrene Scoring Systems on Admission to Predict Mortality: A Systematic Review and Meta-Analysis. J Pers Med 2023; 13:1283. [PMID: 37763051 PMCID: PMC10532663 DOI: 10.3390/jpm13091283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE To systematically review and meta-analyze the predictive value of the Fournier gangrene severity index (FGSI), the simplified FGSI (SFGSI), and the Uludag FGSI (UFGSI) on mortality in patients affected by Fournier's Gangrene (FG). METHODS A search was performed in PubMed, Web of Science, Embase, and the Cochrane Library, from January 2000 to May 2023, to identify original cohorts comparing data between surviving and non-surviving FG patients. The statistical analysis consisted of two parts. First, the mean and standard deviation (SD) of the FGSI, SFGSI, and UFGSI at admission were extrapolated from each study, and the pooled mean difference (MD) with 95% confidence interval (95% CI) was obtained using the Der Simonian-Laird random-effect model. Second, to evaluate the accuracy of the FGSI, SFGSI, and UFSGI in predicting mortality, true positive (TP), false positive (FP), true negative (TN), and false negative (FN) values were extracted where possible and reported in 2 × 2 contingency tables. The sensitivity, specificity, and AUC values were pooled, and summary receiver operating characteristic (SROC) curves were constructed. RESULTS Overall, forty studies comprising 2257 patients were included. The pooled analysis revealed that the FGSI, SFGSI, and UFGSI values at admission were higher in non-survivors than survivors (MD: 5.53 (95% CI: 4.68-6.37); MD: 2.41 (95% CI: 1.06-3.77); and MD: 5.47 (95% CI: 3.68-7.26), respectively). Moreover, the AUC values of the FGSI, SFGSI, and UFGSI were 0.90 (95% CI: 0.87-0.92), 0.84 (95% CI: 0.80-0.87), and 0.94 (95% CI: 0.92-0.96), respectively. CONCLUSIONS The higher scores of the FGSI, SFGSI, and UFGSI on admission were associated with mortality. Moreover, when comparing accuracy rates, the UFGSI exhibited the highest AUC value.
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Affiliation(s)
- Antonio Tufano
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00162 Rome, Italy; (P.D.); (G.F.); (R.S.F.); (F.P.); (L.A.); (G.B.D.P.)
| | - Piervito Dipinto
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00162 Rome, Italy; (P.D.); (G.F.); (R.S.F.); (F.P.); (L.A.); (G.B.D.P.)
| | - Francesco Passaro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Umberto Anceschi
- Department of Urology, “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (U.A.); (C.L.)
| | - Giorgio Franco
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00162 Rome, Italy; (P.D.); (G.F.); (R.S.F.); (F.P.); (L.A.); (G.B.D.P.)
| | - Rocco Simone Flammia
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00162 Rome, Italy; (P.D.); (G.F.); (R.S.F.); (F.P.); (L.A.); (G.B.D.P.)
| | - Flavia Proietti
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00162 Rome, Italy; (P.D.); (G.F.); (R.S.F.); (F.P.); (L.A.); (G.B.D.P.)
- Department of Urology, “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (U.A.); (C.L.)
| | - Luca Antonelli
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00162 Rome, Italy; (P.D.); (G.F.); (R.S.F.); (F.P.); (L.A.); (G.B.D.P.)
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00162 Rome, Italy; (P.D.); (G.F.); (R.S.F.); (F.P.); (L.A.); (G.B.D.P.)
| | - Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy;
| | - Roberta Rullo
- Obstetrics and High-Risk Pregnancy Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy;
| | - Sisto Perdonà
- Istituto Nazionale Tumori di Napoli, IRCCS “Fondazione G. Pascale”, Via M. Semmola, 80131 Naples, Italy;
| | - Costantino Leonardo
- Department of Urology, “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (U.A.); (C.L.)
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Elahabadi I, Bazmandegan G, Salehi H, Jafari A, Ahmadi J, Kamaib Z. Fournier's gangrene after missed acute perforated appendicitis: A case report. Clin Case Rep 2021; 9:e04989. [PMID: 34721858 PMCID: PMC8530021 DOI: 10.1002/ccr3.4989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 09/21/2021] [Accepted: 10/08/2021] [Indexed: 01/10/2023] Open
Abstract
Fournier's gangrene (FG) is a rare progressive necrotizing fasciitis (NF) with high mortality rate. This case report describes a young patient with FG with no known history of disease or invasive therapeutic interventions.
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Affiliation(s)
- Ismail Elahabadi
- Department of SurgeryAli‐Ibn Abi‐Talib HospitalSchool of MedicineRafsanjan University of Medical SciencesRafsanjanIran
| | - Gholamreza Bazmandegan
- Clinical Research Development UnitAli‐Ibn Abi‐Talib HospitalRafsanjan University of Medical SciencesRafsanjanIran
- Department of Family MedicineAli‐Ibn Abi‐Talib HospitalSchool of MedicineRafsanjan University of Medical SciencesRafsanjanIran
| | - Hossein Salehi
- Department of SurgeryAli‐Ibn Abi‐Talib HospitalSchool of MedicineRafsanjan University of Medical SciencesRafsanjanIran
| | - Amin Jafari
- Department of SurgeryAli‐Ibn Abi‐Talib HospitalSchool of MedicineRafsanjan University of Medical SciencesRafsanjanIran
| | - Jafar Ahmadi
- Department of RadiologyAli‐Ibn Abi‐Talib HospitalSchool of MedicineRafsanjan University of Medical SciencesRafsanjanIran
| | - Zahra Kamaib
- Clinical Research Development UnitAli‐Ibn Abi‐Talib HospitalRafsanjan University of Medical SciencesRafsanjanIran
- Department of Family MedicineAli‐Ibn Abi‐Talib HospitalSchool of MedicineRafsanjan University of Medical SciencesRafsanjanIran
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Relationship between diversional stoma and mortality rate in Fournier's gangrene: a systematic review and meta-analysis. Langenbecks Arch Surg 2021; 406:2581-2590. [PMID: 33864128 DOI: 10.1007/s00423-021-02175-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Fournier's gangrene (FG) is a rare potentially lethal necrotising infection of the perineum. While the gold standard management is early and aggressive surgical debridement, the evidence in the literature is unclear as to the role and outcomes of diversional stoma. METHODS A systematic review was conducted to identify studies investigating the relationship between stoma formation and FG. Meta-analyses were performed using a random-effects model. RESULTS Twenty-seven studies (n=1482) were included. There was no significant difference in disease severity scores between the stoma and no stoma groups. Mortality rate was significantly higher in patients who required diversional stoma (OR 1.71, 95% CI 1.13-2.59, p=0.01). Significantly more surgical procedures were performed on patients who underwent stoma formation, and the total hospital cost was also higher in this group. This study may have been limited by bias in patients with more fulminant course or sphincter damage requiring stoma as a medical necessity. CONCLUSION These findings suggest that the use of diversional stoma in FG is a predictor of poor outcomes. This study demonstrated that mortality rate remained high and a diversional stoma did not reduce risk of mortality as suggested by smaller case series. Its use should therefore be individualised based on disease severity and sphincter damage.
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Akan S, Urkmez A. Association between atherogenic dyslipidemia and fournier’s gangrene. Rev Assoc Med Bras (1992) 2020; 66:479-484. [DOI: 10.1590/1806-9282.66.4.479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/12/2019] [Indexed: 11/22/2022] Open
Abstract
SUMMARY OBJECTIVE We aimed to determine whether atherogenic dyslipidemia is associated with the disease and morbidity in our patients treated for Fournier’s gangrene (FG). METHODS Sixty-two patients who were treated with the diagnosis of FG at our center between 2012 and 2017 were retrospectively screened. RESULTS The triglyceride values of the patients who required reconstructive surgery were statistically significantly higher than those of the patients for whom wound debridement and primary suturing was sufficient (p:0.001). A total of 65.7% of the patients had normal triglyceride values in the group in which wound debridement and primary suturing was sufficient, while this rate was 22.2% in the group of patients who needed reconstructive surgery; the difference was statistically significant (p: 0.002). The UFGSI score of those with triglyceride values higher than the normal range was statistically significantly higher (p:0.006). The cut-off point for the triglyceride value for which Fournier’s gangrene was more morbid and the probability of reconstructive surgery need was significantly higher, i.e., >233mg. CONCLUSION Our study has demonstrated that atherogenic dyslipidemia, especially hypertriglyceridemia, is an important factor affecting morbidity and associated with high patient care costs after hospitalization and discharge in FG.
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