BASIC CONCEPTS
AND MODERN AIDS IN THE MANAGEMENT OF FOURNIER'S GANGRENE
Omar Abdel Razek, Sherif Zamer, Tarek
Said and Ahmed Salem
Department
of Urology, General Surgery and Andrology, Kasr El-Aini School of Medicine,
Cairo University.
Kasr El-Aini Journal of Surgery,
Vol (4), No (2), May 2003: 75-80
We treated 9 patients with Fournier's
gangrene with surgical debridement and antibiotics. In one case a temporary
diverting colostomy was needed initial surgical debridement was done with
a eye at preservation of all healthy scrotal skin. This was followed by
the daily use of saline irrigation and "Iruxol" to achieve chemical debridement
of residual necrotic tissue in 4 cases. In the other 5 cases wound care
consisted of daily dressing with povidone iodine followed by the use of
a modern hydrofibre dressing (Aquacel). Delayed primary closure was then
done using residual scrotal skin with no need for scrotal reconstruction.
Following delayed closure 2 cases suffered from minor wound gaping that
healed with repeated dressing. All patients survived and were discharged
in god general condition. The basic concepts for management of Fournier's
gangrene appear to be: debridement of all necrotic tissue which may be
greatly facilitated by the use of aids such as chemical debridement and
hydrofibre dressing, no attempt at reconstruction except after complete
quiescence of infection, preservation of even minimal scrotal skin is valuable
as this is capable of expansion to cover the testis provided there is no
infection.
