A different perspective for morbidity related to Fournier's gangrene: which scoring system is more reliable to predict requirement of skin graft and flaps in survivors of Fournier's gangrene?

PURPOSE

To identify the prognostic factors that might predict morbidity related to Fournier's gangrene (FG) and particularly requirement of skin grafting and flaps. We also evaluated the validities of different severity indexes.

METHODS

Thirty male patients with complete data who were treated for FG between January 2012 and December 2018 were retrospectively evaluated. Fournier's Gangrene Severity Index (FGSI), Uludag Fournier Gangrene Severity Index (UFGSI) and Age-Adjusted Charlson Comorbidity Index (ACCI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, the Combined Urology and Plastics Index (CUPI) and neutrophil-lymphocyte ratio (NLR) were calculated for 27 surviving patients. These patients were divided into two groups: Group I (14 patients with primary skin closure) and Group II (13 patients with requiring skin grafting and flaps).

RESULTS

Body temperature (p = 0.026), heart rate (p < 0.001), respiratory rate (p = 0.029), creatinine (p = 0.002), white blood cell count (p = 0.014), hemoglobin levels (p = 0.018), involvement of pelvic floor or beyond (p = 0.018), length of hospital stay (p = 0.049), previous endourologic instrumentation (p = 0.035), requirement of cystostomy (p = 0.041), colostomy (p = 0.046), orchiectomy (p = 0.034) and intensive care unit (p = 0.046) were found to be significantly higher in Group II. All six different scoring systems were significantly higher in the patients who underwent skin grafting and flaps. In multivariate analysis, heart rate, FGSI, UFGSI, NLR, requirement of colostomy and intensive care unit were determined as independent factors for predicting requirement of skin grafting and flaps.

CONCLUSION

FGSI, UFGSI and NLR are more reliable parameters for predicting skin reconstruction method (with the threshold values of 4.5, 5.5, and 7.87, respectively).