The role of hyperbaric oxygen therapy in treating extensive Fournier's gangrene

Background: Fournier's gangrene (FG) is a rapidly progressive necrotizing infection of the perineal and genital fascia. The disease is always associated with high morbidity and mortality if diagnosed late and treated improperly. Purpose: This paper analyzed the epidemiology of FG, and clarified the treatment strategy of FG of different origins and prognosis. Methods: From January 2007 to December 2015, 60 patients with FG were treated at the Chi Mei Medical Center (Tainan, Taiwan). Their medical records were reviewed and analyzed. Results: Sixty patients were identified: 50 (83.33%) men and 10 (16.66%] women who were aged 29-90 years (mean 59.6 +/- 14.5 years). The most frequent systemic illness was diabetes mellitus (73.33%). The location of FG was in the anorectal region in 21 (35.00%) patients, urogenital region in 25 (41.66%) patients, and dermatological region in 14 (23.33%) patients. The patients underwent from zero to nine surgical debridements with an average of 3.1 surgical debridements. Septic shock was observed in 25 patients. All 14 patients who expired died of sepsis. The survival rates were better for patients who underwent an early colostomy than for patients who underwent a delayed colostomy [20/21 (95.2%) patients vs. 2/7 (22.2%) patients, respectively; p < 0.001]. Patients with septic shock who received hyperbaric oxygen therapy (HBO) had better survival rates than patients who did not have HBO [7/7 (100%) vs. 4/18 (22.22%), respectively; p = 0.0007]. Conclusion: Bacteremia and sepsis are major indicators of the mortality rate for FG. The cornerstones of treatment are early diagnosis, aggressive resuscitation, broad-spectrum antibiotic therapy, early colostomy, and prompt and repeated surgical intervention. Adjuvant HBO therapy led to higher survival rates. Copyright (C) 2015, Taiwan Urological Association. Published by Elsevier Taiwan LLC.