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.
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This impaired blood supply furthers perifascial dissection with spread of bacteria and progression to gangrene of the overlying subcutaneous tissue and skin. Over the years, experience has shown that FG often has an identifiable cause and it frequently manifests indolently. Ferreira and colleagues reviewed 43 cases and found the most common presentations were scrotal swelling, fever and pain [ Ferreira et al.
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CiteScore measures average citations received ve document published. By quantifying the severity of infection using common vital signs temperature, heart rate, respiratory rate and laboratory data serum sodium, serum potassium, serum creatinine, serum bicarbonate, hematocrit and white blood cell countthe FGSI score helps prognosticate progression and predict the mortality.
Kabay and colleagues analyzed patients using this index and showed those with FGSI greater than Arch Esp Urol 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.
J Postgrad Med SRJ is a prestige metric based on the idea that not all citations are the same. Czymek and colleagues prospectively collected data on 35 patients diagnosed with FG to assess the ggangrena of VAC therapy versus daily antiseptic polyhexadine dressings. The degree of deviation from normal is graded from 0 to 4, and individual values are summed to obtain the FGSI score. Other organisms like Bacteroides inhibit the phagocytosis of aerobic bacteria, aiding in further spread of the infection [ Morua et al.
Gangrena de Fournier
Diagnosis The diagnosis of FG is primarily based on clinical findings of fluctuance, crepitus, localized tenderness and wounds of the genitalia and perineum.
Treatment of FG entails treating sepsis, stabilizing medical parameters and urgent surgical debridement. The predisposing and etiologic factors of FG provide a favorable environment for the infection by decreasing the host immunity and allowing a portal of entry for the fisiopatoligia into the perineum.
Moreover, a drain was left in place to allow for irrigation of the graft with Sulfamylon for the first 5 days. West J Em Med Characteristically, FG exists due to synergism between multiple bacteria that theoretically are not highly aggressive when presented alone. In a retrospective study of 19 patients diagnosed with FG, Chawla and colleagues studied the utilization of the FGSI to determine length of stay and survival. Furthermore, length of stay was not affected fournieg urinary or fecal diversion.
Gangrena de Fournier | Cigna
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. World J Emerg Surg 8: In the year has been indexed in the Medlinedatabase, and has become a vehicle for expressing the most current Spanish medicine and modern.
In some series, an average of more than three organisms were cultured from each patient [ Addison et ganngrena. Patients also may have pronounced systemic signs, usually out of proportion to the local extent gantrena the disease. Moreover, no scars or contractures fisiopaologia noted, which the authors attributed to the meshing of the graft.
Usually the infection starts as a cellulitis adjacent to the portal of entry, commonly in the perineum or perineal region, with an insidious presentation. As mentioned previously, testicular involvement in FG is rare and suggests an intraabdominal or retroperitoneal fisioptologia [ Eke, ]. Singapore Med J In regards to urinary diversion, some authors suggest cystostomy, although most suggest that urinary catheterization provides satisfactory diversion [ Yanar et al.
Crit Care Med Cent Eur J Urol A multidisciplinary approach is often necessary as these patients may require reconstructive procedures in the future. Author information Copyright and License information Disclaimer.
Gangrenna of the nine patients experienced genital skin loss secondary to FG.
Even though FG was first described by Baurienne in [ Nathan, ], it is credited to the French venereologist, Jean Alfred Fournier, who fisiopqtologia a detailed description of the disease in as a fulminant gangrene of the penis and scrotum [ Fournier, ].
FGSI has been validated by several studies [ Chawla et al.
Contemporary diagnosis and management of Fournier’s gangrene
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.
Etiology FG was initially defined as an idiopathic entity, but recent research has shown that less bangrena a quarter of FG cases are now considered idiopathic [ Smith et al.
Interestingly, patients treated at teaching hospitals had longer length of stay, greater hospital charges and a higher case fatality rate secondary to more acutely ill patients. Mainstays of treatment include rapid and aggressive surgical debridement of necrotized tissue, hemodynamic support with urgent resuscitation with fluids, and broad-spectrum parental antibiotics.