Fournier's gangrene. Etiology, diagnosis, and treatment
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Abstract
Background: Fournier's Gangrene (FG) is a severe necrotizing infection of soft tissues, primarily affecting the perineum, genitals, and lower abdomen. Although rare, its high mortality and rapid progression demand a comprehensive understanding of its management. Objective: This review aims to evaluate the clinical, diagnostic, and therapeutic aspects of Fournier's gangrene, providing an updated overview of its management and outcomes. Methodology: A comprehensive literature review was conducted, focusing on recent and relevant studies on Fournier's gangrene. Articles addressing clinical management, diagnosis, therapeutic interventions, and associated comorbidities were evaluated. Results: The reviewed studies indicate that Fournier's gangrene is often associated with comorbidities such as diabetes mellitus and urological diseases. Early detection and prompt surgical intervention are crucial for improving prognosis. Standard treatment involves aggressive surgical debridement, broad-spectrum antibiotic therapy, and management of underlying conditions. Despite advancements in treatment strategies, mortality rates remain high. Conclusion: Fournier's gangrene is a medical emergency that requires rapid intervention and a multidisciplinary approach. The combination of early debridement, appropriate antibiotic therapy, and management of comorbidities is essential for improving outcomes and reducing mortality. Ongoing research is needed to optimize treatment strategies and improve the quality of life for affected patients. General area of study: medicine. Specific study area: general surgery and coloproctology. Type of study: narrative review.
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Leslie SW, Rad J, Foreman J. Fournier gangrene. Clinical Case Reports. StatPearls Publishing [Internet]. 2024 [citado 15 septiembre 2024]; 3: 198–199. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31747228/
Lewis GD, Majeed M, Olang CA, Patel A, Gorantla VR, Davis N, Gluschitz S. Fournier’s gangrene diagnosis and treatment: A systematic review. Cureus [Internet]. 2021 [citado 15 septiembre 2024]: 13(10). Disponible en: https://doi.org/10.7759/cureus.18948
Insua-Pereira I, Ferreira PC, Teixeira S, Barreiro D, Silva A. Fournier’s gangrene: a review of reconstructive options. Central European Journal of Urology [Internet]. 2020 [citado 15 septiembre 2024]; 73(1): 74–79. Disponible en: https://doi.org/10.5173/ceju.2020.0060
El-Qushayri AE, Khalaf KM, Dahy A, Mahmoud AR, Benmelouka AY, Ghozy S, Mahmoud MU, Bin-Jumah M, Alkahtani S, Abdel-Daim M. Fournier’s gangrene mortality: a 17-year systematic review and meta-analysis. International Journal of Infectious Diseases [Internet]. 2020 [citado 15 septiembre 2024]; 92: 218–225. Disponible en: https://doi.org/10.1016/j.ijid.2019.12.030
Zhang JY, Xiao CF, Wang C, Yao YB. Bibliometric insights in Fournier’s gangrene: Research landscapes, turning points, and global trends. Frontiers in Surgery [Internet]. 2023; 10. Disponible en: https://doi.org/10.3389/fsurg.2023.1057486
Chowdhury T, Gousy N, Bellamkonda A, Dutta J, Zaman CF, Zakia UB, Tasha T, Dutta P, Roy PD, Gomez AM, Mainali A. Fournier’s gangrene: A coexistence or consanguinity of SGLT-2 inhibitor therapy. Cureus [Internet]. 2022 [citado 15 septiembre 2024]; 14(8). Disponible en: https://doi.org/10.7759/cureus.27773
Bowen D, Hughes T, Juliebø-Jones P, Somani B. Fournier’s gangrene: a review of predictive scoring systems and practical guide for patient management. Therapeutic Advances in Infectious Disease [Internet]. 2024 [citado 15 septiembre 2024]; 11. Disponible en: https://doi.org/10.1177/20499361241238521
Maier S, Eckmann C. Fournier’s gangrene as a special form of necrotizing fasciitis. Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen [Internet]. 2020 [citado 15 septiembre 2024]; 91(4): 307–312. Disponible en: https://doi.org/10.1007/s00104-019-01095-5
Flores-Galván KP, Aceves Quintero CA, Guzmán Valdivia-Gómez G. Gangrena de Fournier. Cirujano General [Internet]. 2021 [citado 15 septiembre 2024]; 43(2): 107–114. Disponible en: https://doi.org/10.35366/106721
Montrief T, Long B, Koyfman A, Auerbach J. Fournier gangrene: a review for emergency clinicians. The Journal of Emergency Medicine [Internet]. 2019 [citado 15 septiembre 2024]; 57(4): 488–500. Disponible en: https://doi.org/10.1016/j.jemermed.2019.06.023
Zhang KF, Shi CX, Chen SY, Wei W. Progress in multidisciplinary treatment of Fournier’s gangrene. Infection and drug resistance [Internet]. 2022 [citado 15 septiembre 2024]; 15: 6869–6880. Disponible en: https://doi.org/10.2147/idr.s390008
Serrano Olave A, Bueno Moral AI, Martínez Bañón C, González Mesa E, Jiménez López JS. Fournier’s gangrene under sodium-glucose cotransporter-2 inhibitors therapy in gynecological patients. International Journals of Environmental Research and Public Health [Internet]. 2022 [citado 15 septiembre 2024]; 19(10). Disponible en: https://doi.org/10.3390/ijerph19106261
Radcliffe RS, Khan MA. Mortality associated with Fournier’s gangrene remains unchanged over 25 years. BJU International [Internet]. 2020 [citado 15 septiembre 2024]; 125(4): 610–616. Disponible en: https://doi.org/10.1111/bju.14998
Bowen D, Juliebø-Jones P, Somani BK. Global outcomes and lessons learned in the management of Fournier’s gangrene from high-volume centres: findings from a literature review over the last two decades. World Journal of Urology [Internet]. 2022 [citado 15 septiembre 2024]; 40(10): 2399–23410. Disponible en: https://doi.org/10.1007/s00345-022-04139-4
Khalid A, Devakumar S, Huespe I, Kashyap R, Chisti I. A comprehensive literature review of Fournier’s gangrene in females. Cureus [Internet]. 2023 [citado 15 septiembre 2024]; 15(5). Disponible en: https://doi.org/10.7759/cureus.38953
Escudero-Sepúlveda AF, Cala-Duran JC, Belén-Jurado M, Tomasone SE, Carlino-Currenti VM, Abularach-Borda R, Roccuzzo C, Puche-Burgos JF, Acosta-Maestre JE. Conceptos para la identificación y abordaje de la gangrena de Fournier. Revista Colombiana de Cirugía [Internet]. 2022 [citado 15 septiembre 2024]; 37(4): 653–664. Disponible en: https://doi.org/10.30944/20117582.930
Mirón Fernández I, León Díaz FJ, Pérez Reyes M, Santoyo Santoyo J. Uso de terapia de presión negativa en gangrena de Fournier. Cirugía Andaluza [Internet]. 2021 [citado 15 septiembre 2024]; 32(3): 416–418. Disponible en: https://doi.org/10.37351/2021323.15
Guerra Marcial PA, Guerrero Castillo GS, Cartagena Samaniego MI, Marín Arias AM. Gangrena de Fournier: diagnóstico, fisiopatología, manejo conservador y tratamiento quirúrgico, un artículo de revisión. Polo del Conocimiento [Internet]. 2023 [citado 15 septiembre 2024]; 8(6): 1384–1398. Disponible en: https://doi.org/10.23857/pc.v8i6
Motta-Ramírez GA, Martínez-Martínez A, Santiago-González E. Fascitis necrotizante de las regiones perianal, perineal y genital. Anales de Radiología México [Internet]. 2023 [citado 15 septiembre 2024]; 22: 300–316. Disponible en: https://doi.org/10.24875/ARM.23000027
Vargas Rubio T, Mora Agüero SA, Zeledón Aguilera AS. Gangrena de Fournier: generalidades. Revista Médica Sinergia [Internet]. 2019 [citado 15 septiembre 2024]; 4(6): 100–107. Disponible en: https://doi.org/10.31434/rms.v4i6.217
Itaimi A, Triki W, Abbassi I, Ayed K, Baraket O, Bouchoucha S. Fournier’s gangrene: validation of the severity index. La Tunise Médicale [Internet]. 2022 [citado 15 septiembre 2024]; 100(2): 122. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272447/
Calderón W, Camacho JP, Obaíd M, Moraga J, Bravo D, Calderón D. Tratamiento quirúrgico de la gangrena de Fournier. Revista de Cirugía (México) [Internet]. 2021 [citado 15 septiembre 2024]; 73(2): 150–157. Disponible en: https://doi.org/10.35687/s2452-45492021002748
Huayllani MT, Cheema AS, McGuire MJ, Janis JE. Practical review of the current management of Fournier’s gangrene. Plastic and Reconstructive Surgery. Global Open [Internet]. 2022 [citado 15 septiembre 2024]; 10(3). Disponible en: https://doi.org/10.1097/GOX.00000000000000004191
Hughes T, Bowen D, Saeed K, Juliebø-Jones P, Somani B. Management of Fournier’s gangrene: a practical guide for clinicians. British Journal of Hospital Medicine (London) [Internet]. 2023 [citado 15 septiembre 2024]; 84(9). Disponible en: https://doi.org/10.12968/hmed.2023.0119
Sandoval J, Aldana C, Balmelli B. Características epidemiológicas y quirúrgicas en pacientes con secuelas de enfermedad de Fournier. Anales de la Facultad de Ciencias Médicas (Asunción) [Internet]. 2023 [citado 15 septiembre 2024]; 56(3): 67–75. Disponible en: https://doi.org/10.18004/anales/2023.056.03.67
Vijayalakshmi V, Girieasen S, Deepika S, Kannan R, Kumar MSK. Multimodal management of Fournier’s gangrene with subsequent wound closure techniques. International Surgery Journal [Internet]. 2022 [citado 15 septiembre 2024]; 9(2): 459. Disponible en: https://doi.org/10.18203/2349-2902.isj20220342
Ramírez Antúnez P, Aldana C, Peña A, Berra P. Reconstrucción escrotal con colgajo pediculado del músculo gracilis bilateral e injerto de piel parcial. Anales de la Facultad de Ciencias Médicas (Asunción) [Internet]. 2023 [citado 15 septiembre 2024]; 56(1): 103–108. Disponible en: https://doi.org/10.18004/anales/2023.056.01.103
Raizandha MA, Hidayatullah F, Kloping YP, Rahman IA, Djatisoesanto W, Rizaldi F. The role of hyperbaric oxygen therapy in Fournier’s gangrene: a systematic review and meta-analysis of observational studies. Official Journal of the Brazilian Society of Urology [Internet]. 2023 [citado 15 septiembre 2024]; 53:100702. Disponible en: https://doi.org/10.1016/j.ijso.2023.100702
Khalid A, Devakumar S, Huespe I, Kashyap R, Chisti I. A comprehensive literature review of Fournier’s Gangrene in Females. Cureus [Internet]. 2023 [citado 15 septiembre 2024]; 15(5). Disponible en: https://doi.org/10.7759/cureus.38953