Fournier gangrene - a challenge for the surgeon

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Abstract
Introduction: Fournier gangrene (FG) is a life-threatening condition, defined as necrotizing fasciitis of the perineum and can spread to adjacent areas. It is a rare disease and the infection is caused by mixed bacterial flora, seldom by fungal infection. The risk factors include male sex, diabetes, hypertension, malignant neoplasms, alcoholism, immunosuppression. Material and methods: The diagnostic and therapeutic process and prognosis assessment using the FGSI (Fournier's Gangrene Severity Index) scale were analyzed in a group of four patients treated for Fournier gangrene. Results: All patients were males. The average age at the moment of diagnosis was 60. All of the patients had comorbidities resulting with a higher risk of susceptibility to FG. Morbidity was 50%, despite the fact that all patients scored less than 9 points in the FGSI. Discussion: Despite better diagnostic tools and technological progress, FG remains a significant clinical issue due to mortality at a level of 80%. The "golden standard" is surgical excision of necrotic tissues. Broad-spectrum antibiotic therapy, fluid resuscitation, correction of electrolyte and acid-base disorders, and the level of glycemia are very important. Treatment results were assessed on the basis of the FGSI. The moment of surgical intervention is decisive - it has been proven that it is best to perform it on the first day. Hyperbaric oxygen therapy is controversial, with no studies confirming the effectiveness of this procedure. It seems appropriate if the infection is caused by anaerobic bacteria. Conclusions: Fournier syndrome is a significant clinical issue. Treatment requires an early surgical approach with excision of necrotic tissues, broad-spectrum antibiotic therapy and treatment with hyperbaric oxygen in some cases.

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