Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Fournier gangrene medical therapy
Introduction
Steven C. Campbell, M.D., Ph.D.; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[1]; Jesus Rosario Hernandez, M.D. [2]
Overview
Overview
Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if sepsis is already present at the time of initial hospital admission.[1] The spread of gangrene is rapid at the rate of 2–3 cm/h, hence early diagnosis and emergency surgical treatment is important.[2]
Medical Therapy
Medical Therapy
Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if sepsis is already present at the time of initial hospital admission.[1] The spread of gangrene is rapid at the rate of 2–3 cm/h, hence early diagnosis and emergency surgical treatment is important.[2]
Antimicrobial Therapy
- Fournier gangrene[3]
- If caused by streptococcus species or clostridia
- Preferred regimen: Penicillin G
- Polymicrobial
-
- MRSA (methicillin resistant staphylococcus aureus) suspected
- Preferred regimen: vancomycin OR daptomycin
Nutritional Support
The metabolic demands of Fournier gangrene patients are similar to those of other major trauma or burns.[4] Nutritional support to replace lost proteins and fluids from large wounds and/or the result of shock is required from the first day of a patient’s hospital admission.
Hyperbaric oxygen
- Delivery of 100% oxygen (hyperbaric) at two or three times the atmospheric pressure for 30 to 90 minutes with three to four treatments daily.[5]
- Hyperbaric oxygen inhibits infection and exotoxin release.[6]
- It enhances efficacy of antibiotics by increasing local oxygen tension in tissue and augment oxidative burst and killing ability of leukocytes.[7]
- These effects result in a reduced need for surgical debridement and improved morbidity and mortality in patients with necrotizing fasciitis.
Contraindications to hyperbaric oxygen are:[8][9]
- Pneumothorax
- Cisplatin (which decreases the production of superoxide dismutase which is protective against damaging effects of high partial O2 pressure)
- Doxorubicin therapy
Side effects of hyperbaric oxygen are:
- Barotrauma of the middle ear
- Seizures
- Loss of respiratory drive in hypercapnic patients (therefore, frequent periods of breathing in room air are interposed when patients are on HBOT)
- Vasoconstriction
IV γ-globulin
- Use of intravenous immune globulin is not FDA approved.
- If used, this treatment is restricted to critically ill patients with either staphylococcal or streptococcal infections.[10]
References
References
- ↑ 1.0 1.1 Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N; et al. (2006). “Fournier’s gangrene: risk factors and strategies for management”. World J Surg. 30 (9): 1750–4. doi:10.1007/s00268-005-0777-3. PMID 16927060.
- ↑ 2.0 2.1 Paty R, Smith AD (1992). “Gangrene and Fournier’s gangrene”. Urol Clin North Am. 19 (1): 149–62. PMID 1736475.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A (2014). “Current concepts in the management of necrotizing fasciitis”. Front Surg. 1: 36. doi:10.3389/fsurg.2014.00036. PMC 4286984. PMID 25593960.
- ↑ Escobar SJ, Slade JB, Hunt TK, Cianci P (2005). “Adjuvant hyperbaric oxygen therapy (HBO2)for treatment of necrotizing fasciitis reduces mortality and amputation rate”. Undersea Hyperb Med. 32 (6): 437–43. PMID 16509286.
- ↑ Korhonen K (2000). “Hyperbaric oxygen therapy in acute necrotizing infections with a special reference to the effects on tissue gas tensions”. Ann Chir Gynaecol Suppl (214): 7–36. PMID 11199291.
- ↑ Hyperbaric oxygen therapy. http://onlinelibrary.wiley.com/doi/10.1080/110241500750008583/abstract (2016) Accessed on September 12, 2016
- ↑ Kindwall EP, Gottlieb LJ, Larson DL (1991). “Hyperbaric oxygen therapy in plastic surgery: a review article”. Plast Reconstr Surg. 88 (5): 898–908. PMID 1924583.
- ↑ Capelli-Schellpfeffer M, Gerber GS (1999). “The use of hyperbaric oxygen in urology”. J Urol. 162 (3 Pt 1): 647–54. PMID 10458334.
- ↑ Darabi K, Abdel-Wahab O, Dzik WH (2006). “Current usage of intravenous immune globulin and the rationale behind it: the Massachusetts General Hospital data and a review of the literature”. Transfusion. 46 (5): 741–53. doi:10.1111/j.1537-2995.2006.00792.x. PMID 16686841.