Fournier’s gangrene, an obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the overlying skin, is a rare but severe infective necrotizing. Profile of patients with Fournier’s gangrene and their clinical evolution. Perfil dos pacientes com gangrena de Fournier e sua evolução clínica. DJONEY RAFAEL. La gangrena de Fournier es una infección grave de la zona genital de los ciertas afecciones corren un mayor riesgo de llegar a tener gangrena de Fournier.
FGSI has been validated by several studies [ Chawla et fpurnier. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. Author information Copyright and License information Disclaimer. The laboratory values most often predictive of worse prognosis include increased leukocyte counts, creatinine, creatine kinase, urea, lactate dehydrogenase, alkaline phosphatase, and decreased levels of hematocrit, bicarbonate, sodium, potassium, calcium, total protein and albumin [ Clayton fisiopafologia al.
Contemporary diagnosis and management of Fournier’s gangrene
As the subcutaneous inflammation worsens, necrosis and suppuration of subcutaneous tissues progresses to extensive necrosis [ Laucks li, ]. By quantifying the severity of infection using common vital signs temperature, heart rate, respiratory rate and laboratory gangrens serum sodium, serum potassium, serum creatinine, serum bicarbonate, hematocrit and white blood cell countthe FGSI score helps prognosticate progression and predict the mortality.
Overall, the authors analyzed cases of FG at a total of hospitals.
Colostomy has been used for fecal diversion in cases of severe perineal involvement. Characteristically, FG exists due to synergism between multiple bacteria that theoretically are not highly aggressive when presented alone. After initial radical debridement, open wounds are generally managed with sterile dressings or negative-pressure wound therapy.
Moreover, the authors found that its application may prove most useful in patients with extensive and contaminated penoscrotal defects [ Lee et al. Temporary thigh pouches to harbor the testicles may be utilized in scenarios when significant tissue loss may preclude complex scrotal reconstruction in the acute setting Figure 4 [ Akilov et al.
The organisms that tend to be found in FG are species that normally exist below the pelvic diaphragm in the perineum and genitalia [ Eke, ].
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After initial radical debridement, open wounds are generally managed with sterile dressings and negative-pressure wound therapy. The use of topical honey has also been described in the management of FG because of its ability to inhibit microbial growth likely related to the osmotic effect of its high sugar content [ Tahmaz et al.
In some series, an average of more than three organisms were cultured from fusiopatologia patient [ Addison et al. Can Urol Assoc J 7: Moreover, the flap was found to be less bulky than a gracilis flap with minimal donor site morbidity [ Chen et al. Si continua navegando, consideramos que acepta su uso.
Alternatively, clindamycin and chloramphenicol can be substituted empirically to facilitate coverage of gram-positive cocci and anaerobes until culture results return [ Martinez-Rodriguez et al.
The anaerobic bacteria promote the formation of clots by producing collagenase and heparinase.
Other organisms like Bacteroides inhibit the phagocytosis of aerobic bacteria, aiding in further spread of the infection [ Morua et al. Also, this promotes and accelerates the formation of granulation tissue by removing bacterial contamination, end products, exudates and debris compared with traditional dressing [ Ozkan et al. Report of 45 cases. This finding is likely attributable to more aggressive diagnosis and management of FG at experienced hospitals. Patients can rapidly deteriorate as sepsis and multiorgan failure, the most common cause of death in these cases, develop [ Sutherland and Meyer, ].
Triple antibiotic therapy consisting of a broad-spectrum penicillin or third-generation cephalosporins, an aminoglycoside e. The incident leading to the inoculation may be so trivial that the patient or physician may fisiiopatologia to notice. Fecal and urinary diversion Colostomy has been used for fecal diversion in cases of severe perineal involvement. Tightness around the corona or base of the penis during erection was reported but was found to have resolved after 6 months.
ANZ J Surg In addition to broad-spectrum parental antibiotics, early and aggressive surgical debridement has been shown to improve survival in patients presenting with FG as patients often undergo more than fisioatologia debridement during their hospitalization [ Corman et al.
Primary closure of scrotum after debridement. However, significantly more patients required fecal diversion in the group receiving VAC therapy because of the need to reapply the vacuum dressing gangrfna each bowel movement.
Contemporary diagnosis and management of Fournier’s gangrene
Overall, US is considered superior to conventional radiography as soft tissue air is more obvious and scrotal contents along with Doppler blood flow can be examined. Over the years, experience has shown that FG often has an identifiable cause and it frequently manifests indolently. Indian J Urol Subsequently, there is spread to the overlying skin with sparing of the muscles.
Moreover, no scars or contractures were noted, which the authors attributed to the meshing of the graft.
Gangrena de Fournier | Cigna
The infection in FG tends to spread along the fascial planes with initial involvement of the superficial Colles fascia and deep fascial planes of the genitalia. You can change the settings or obtain fisiopatologiw information by clicking here. J Postgrad Med Scand J Infect Dis January – February Pages No financial disclosures to report for other authors. Int J Urol
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