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Introduction: Perineal gangrene is a potentially lethal disease whose cure depends on rapid diagnosis and surgical intervention.
Materials & Methods: We identified 36 patients at our institution from 7/95-11/10 diagnosed with Fourniers/perineal gangrene. Fourniers Gangrene Severity Index(FGSI) was used to stratify illness severity. Wound closure was performed by split-thickness skin-graft (STSG), primary-closure, or healing by secondary-intention.
Results: Median age of patients in this series was 54 years (33-91). Median length of stay was 19 days (6-92) and number of surgical procedures was 4 (1-10). 4 patients (11%) were bacteremic at presentation. Median WBC was 18.2 th/mm3 (8.9-37.0), and creatinine was 1.3 mg/dl (0.7-7.4). Median FGSI was 5 (0-16), and follow-up was 19 months (0-99). The most common comorbidities were hypertension (58%), type-2 diabetes (47%), alcoholism (14%), end-stage renal failure (14%), and coronary artery disease (14%). The most common etiologies were GU trauma (25%), perirectal abscess (17%), and GU instrumentation (11%). The most common wound culture pathogens were coagulase-negative Staphylococcus (33%) and beta-hemolytic Streptococcus (28%). Mortality <7 days was 6% (2 pts), <30 days was 9% (3 pts), and <1 year was 9%. 12 patients (33%) underwent STSG, 10 (28%) were closed primarily, and 14 (39%) healed by secondary-intention.
Conclusions: There is a spectrum of severity in patients with perineal gangrene with the most severe form classically referred to as Fourniers. This accounts for the variable mortality reported for this disease. Irrespective of initial presentation the cosmetic and functional Results of wound closure were excellent for all those who survived.