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.
|Published (Last):||11 April 2013|
|PDF File Size:||12.88 Mb|
|ePub File Size:||18.68 Mb|
|Price:||Free* [*Free Regsitration Required]|
In addition to demonstrating significant swelling of the scrotal soft tissue, radiographs may also detect subcutaneous emphysema extending from the scrotum and perineum to the inguinal regions, anterior abdominal wall and thighs.
As the rate of fascial necrosis has been noted as high as 2—3 cm per hour, FG is considered a surgical emergency with prompt, pragmatic and fourhier therapy being the cornerstone for effective treatment [ Eke, ; Safioleas et al. As a result of these defects, ensuing exposure of the testicles in the male patient presents a substantial challenge for fisiopatollgia.
Gangrena de Fournier | Cigna
Interestingly, patients treated at teaching hospitals had longer length of stay, greater hospital charges and a d case fatality rate secondary to more acutely ill patients.
All the patients were men, SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. The nidus fisiopatologla the synergistic polymicrobial infection is usually agngrena in the genitourinary tract, lower gastointestinal tract or skin. Despite longer hospitalization compared with those undergoing wound debridement with systemic antibiotics, treatment with topical honey obviated the need for anesthesia and expenses associated with surgical operations.
This finding is likely attributable to more aggressive diagnosis and management of FG at experienced hospitals. Therefore, it is recommended that stoma formation be reserved for patients with fecal incontinence caused by extensive damage to the anal sphincter [ Ozturk et al.
This item has received. In addition, US can demonstrate paratesticular fluid, which is seen prior to clinical crepitus. Report of 45 cases.
Pemphigus Vegetans in the Inguinal Folds. The underlying cause of FG, such as a perianal abscess, a fistulous tract, or an intraabdominal or retroperitoneal infectious process, may also be demonstrated by CT [ Rajan and Scharer, ]. Author information Copyright and License information Disclaimer. In their study of 44 patients presenting with FG, Ozturk and colleagues found that in 18 patients that required temporary stoma formation, significant increases in healthcare costs were observed without an effect on outcomes.
Tahmaz and colleagues found the efficacy of unprocessed honey to be similar in a retrospective review of 33 patients treated with topical honey versus radical surgical debridement [ Tahmaz et al.
Characteristically, FG exists due to synergism between multiple gnagrena that theoretically are not highly aggressive when presented alone. Using a weighted point system of multiple laboratory gajgrena, the Laboratory Risk Indicator for Necrotizing Fasciitis LRINEC score is often used to stratify patients into low, moderate or high risk for necrotizing soft tissue infections [ Wong et al.
After extensive debridement, many patients sustain significant defects of the skin and soft tissue, creating a need for reconstructive surgery for wound coverage as well as satisfactory functional and cosmetic results Figure 3. Can J Surg SRJ is a prestige metric based on the idea that not all citations are the same. Though orchiectomy is rarely required, it may be necessary in situations of extensive tissue damage in the surrounding scrotum, groin and perineum leading to difficult dressing changes [ Ghnnam, ].
Overall, the authors analyzed cases of FG at a total of hospitals. Results All the patients were men, In a review of fournire cases of FG treated ds a university medical center, Hollabaugh and colleagues utilized suprapubic diversion in 16 cases with 15 of those patients receiving fisjopatologia at the time of initial debridement.
Open in a separate window. Alternatively, the Flexi-Seal Fecal Management System has been introduced for fecal diversion, which can be utilized as an alternative method to colostomy as it successfully prevents fecal contamination of the wound [ Ozkan et al. Full-thickness skin grafts FTSGs are thought to provide superior cosmetic results.
In this case review, all four patients reported satisfaction with their gangren and functional results. Actas Urol Esp Cent Eur J Urol Overall, the data in the study revealed that hospitals where more patients with FG are treated had lower mortality rates, supporting the need to regionalize care for patients with this disease [ Sorensen et al.
However, imaging modalities may be useful in cases when the presentation is atypical or when there is concern regarding the true extent of the disease.
Etiology FG was initially defined as an idiopathic entity, but recent research has shown that less than a quarter of FG cases are now considered idiopathic [ Smith et al.
Lee and colleagues described the use of unilateral gracilis muscle flap reconstruction combined with the internal pudendal artery perforator flap for reconstruction of extensive penoscrotal defects. In patients infected with methicillin-resistant S.
Contemporary diagnosis and management of Fournier’s gangrene
Furthermore, length of stay was not affected by urinary or fecal diversion. Meshed split-thickness skin graft with acceptable cosmetic result.
Although the condition is infrequent, the high associated health care fisiopatolovia suggest that primary and secondary prevention measures should be implemented.