Hyperbaric oxygen in the treatment of Fournier's gangrene.

OBJECTIVE

To investigate the efficacy of operation, antibiotic treatment, hyperbaric oxygen, and surgical intensive care in the management of Fournier's gangrene.

DESIGN

Retrospective study.

SETTING

University hospital, Finland.

SUBJECTS

33 patients, most of them referred from other hospitals.

INTERVENTION

Debridement, broad spectrum antibiotics, and hyperbaric oxygen (HBO) treatment at 2.5 atmospheres absolute pressure. Excision of necrotic tissue and incisions in the affected areas. Urinary and faecal diversions when necessary.

MAIN OUTCOME MEASURES

Morbidity and mortality.

RESULTS

Only three patients died (9%). Hyperbaric oxygen reduced systemic toxicity, prevented extension of the necrotising infection, and increased demarcation, thereby improving the overall outcome.

CONCLUSION

To reduce mortality and morbidity, effective treatment of Fournier's gangrene should be started promptly. Debridement and antibiotics combined with surgical intensive care must be started as soon as possible. Hyperbaric oxygen is both life and tissue saving. It is an important adjunct that prevents extension of necrosis and reduces systemic toxicity.