The role of hyperbaric oxygen in the management of Fournier's gangrene.

Fournier's gangrene of the external genitals is a complex entity characterized by acute onset, rapid progress to gangrene, toxemia and high mortality rate. The disease may be primary as described by Fournier or secondary with a detectable cause in the colo-rectal area, the lower urogenital tract or in the perineum. The disease may affect healthy young males (originally described by Fournier) or elderly subjects especially with general ill health, cancer, diabetes, liver or renal failure, immunosuppression, etc. The microbiology is as complex as the etiology. The nosiology is likewise complex. Because the mortality is high, it is important to be aggressive in therapy. Triple attack is necessary, viz.: antibiotic coverage for aerobes and anaerobes, general supportive measures and adequate surgical debridement. We, recommend Hyperbaric Oxygen Therapy (HBO) treatment in specialized centers as an adjunctive measure since we had no mortality in the cases we treated. In expert centers, HBO has very few complications which are outweighed by the benefit the patient gets. The one-man chamber is the commonest in use, but for a compromised patient the multiplace may be more appropriate. In the very early stage, HBO may avert gangrene or reduce it. It is important to have a high index of awareness of this disease amongst the medical profession. More work is needed for the more precise definition, classification and management of the complex syndrome of Fournier.