Milanese Giulio, Quaresima Luigi, Dellabella Marco, Scalise Alessandro, Di Benedetto Giovanni Maria, Muzzonigro Giovanni, Minardi Daniele
Department of Clinic and Specialistic Sciences, Urology, Polytechnic University of the Marches Region, A.O. Ospedali Riuniti Ancona.
Arch Ital Urol Androl. 2015 Mar 31;87(1):28-32. doi: 10.4081/aiua.2015.1.28.
Fournier's gangrene (FG) is a disease involving necrosis of perineum and external genitalia; in 95% of cases it is possible to diagnose the Fournier's gangrene just by physical examination. The clinical presentation of FG varies from an initial localized infection to large areas with necrotizing infection. The disease typically affect elderly men (6°-7° decade) with important systemic comorbidities; women are less frequently affected. Despite improvements in diagnosis and management, the mortality rate nowadays is between 20% and 43%. The severity and mortality of the disease is dependent upon the general condition of the patient at presentation and upon the rate of spread of the infection. Treatment involves a multidisciplinary approach: intensive systematic management, broad-spectrum antibiotic therapy, early surgical debridement (wide abscission of necrotic tissues and surgical drainage of peritoneum, scrotum, penis, and inguinal areas), hyperbaric oxygen therapy; surgery can eventually be repeated if necessary; reconstructive surgery has an important role in the final treatment of the disease. The technical difficulties frequently encountered and the inability to make a complete removal of the necrotizing tissues at the time of surgery in some cases has led to the application of combined techniques, in view of the enhancement effect of specific advanced medications, targeted antibiotic therapy and hyperbaric medicine. We have considered 6 patients affected by Fournier's gangrene treated at our institution; all the patients received treatment with the help of plastic surgeons of the same institution. After debridement, all the patients were treated with advanced specific dressings consisting of plates and strips made of calcium alginate, hydrogels and polyurethane and twodimensional cavity foams. Reconstructive surgery was necessary in one case. Hyperbaric oxygen therapy (HBO) has been performed in all cases. The multidisciplinary approach, the combined use of HBO therapy and the adoption of advanced specific dressings, have made possible the complete healing of the lesions in a shorter period, avoiding further surgery in 5 out of 6 patients.
福尼尔坏疽（FG）是一种累及会阴和外生殖器坏死的疾病；95%的病例仅通过体格检查就能诊断出福尼尔坏疽。FG的临床表现从最初的局部感染到大面积的坏死性感染不等。该疾病通常影响患有重要全身合并症的老年男性（60 - 70岁）；女性受影响的频率较低。尽管在诊断和治疗方面有所改进，但如今死亡率在20%至43%之间。疾病的严重程度和死亡率取决于患者就诊时的一般状况以及感染的扩散速度。治疗采用多学科方法：强化系统管理、广谱抗生素治疗、早期手术清创（广泛切除坏死组织并对腹膜、阴囊、阴茎和腹股沟区域进行手术引流）、高压氧治疗；如有必要，手术可最终重复进行；重建手术在该疾病的最终治疗中起重要作用。鉴于特定先进药物、靶向抗生素治疗和高压医学的增强效果，手术中经常遇到的技术困难以及在某些情况下无法在手术时完全清除坏死组织，导致了联合技术的应用。我们考虑了在我们机构接受治疗的6例福尼尔坏疽患者；所有患者均在同一机构的整形外科医生的帮助下接受治疗。清创后，所有患者均接受了由藻酸钙、水凝胶和聚氨酯制成的板条以及二维腔泡沫组成的先进特殊敷料治疗。1例患者需要进行重建手术。所有病例均进行了高压氧治疗（HBO）。多学科方法、HBO治疗的联合使用以及先进特殊敷料的采用，使得病变在更短的时间内完全愈合，6例患者中有5例避免了进一步手术。
