Management of Fournier’s gangrene: our experience

BACKGROUND: Fournier’s gangrene is a severe condition with a high mortality rate, requiring emergency surgical treatment. Improving its efficacy remains a pressing issue in urology and surgery. AIM: To analyze the clinical course and treatment outcomes of Fournier’s gangrene. MATERIALS AND METHODS: This article presents an analysis of the clinical course and treatment outcomes of 42 patients with Fournier’s gangrene treated in medical institutions in the Arkhangelsk region from 2005 to 2024. All patients were men aged 19 to 93 years (mean age 49.6 years). RESULTS: Spread of gangrene beyond the genital area was observed in 36 patients (85.7%). The purulent process most frequently affected the perineal tissues (22 patients; 52.4%), often extending to the gluteal regions and pelvic soft tissues. Emergency surgical treatment was performed with excision of necrotic tissues. Subsequently, patients required staged surgical debridement at 1–2 day intervals. The number of these procedures ranged from 1 to 8. A total of 139 operations were performed (an average of 3.3 per patient). The maximum skin defect area was 467 cm2, and the length of the largest linear wound measured 109 cm. Seven patients (16.7%) required readmission for delayed reconstructive surgeries. These included urethral fistula repair in three cases, penile urethral stricture repair in one case, orchiopexy in two cases, and colostomy closure in one case. The mean period of hospital treatment was 32.6 days, with a mortality rate of 21.4%. CONCLUSIONS: Hospitalization and initiation of treatment in patients with Fournier’s gangrene should be performed on an emergency basis. Excision of necrotic tissues must be radical, extending into healthy tissues during the initial and subsequent surgical debridement. The outcome of the condition largely depends not only on the timeliness and adequacy of therapeutic measures but also on the severity of immunocompromising predisposing factors and underlying diseases.