The limited impact of involved surface area and surgical debridement on survival in Fournier's gangrene

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Abstract
Objective To evaluate the influence of involved surface area (extent of disease) and the number and timing of surgical debridements on survival in patients with Fournier's gangrene. Patients and methods The medical records of 30 patients with Fournier's gangrene treated over a 15‐year period were reviewed. The extent of disease was quantified and expressed as a percentage of the body surface area by applying a modified diagram used to assess burn injuries. The number of surgical debridements and their timing with respect to initial presentation and to each other were also analysed. Patients were stratified by outcome (survival or death) and the data evaluated by Student's t‐test, Fisher's exact test and regression analysis. Results Of 30 patients treated 13 died (43%) and 17 survived (57%). The mean surface area involved by disease among survivors was 4.3% (range 1–16.5%) and 7.2% (range 5–20.5%) for non‐survivors (P = 0.10). Whilst no direct correlation between death rate and extent of disease existed, patients with 5% of body surface area involved were more likely to succumb to the disease. Finally, the number of surgical debridements, even if first performed within 24 h of presentation, had no impact on outcome in patients with Fournier's gangrene.

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