This document summarizes a study of 39 cases of Fournier's gangrene managed at a hospital in Pakistan over 5 years. Key findings include:
- Most patients were male (89.74%) with a mean age of 46 years. The most common underlying condition was poor general health/malnutrition (82.05%).
- The scrotum was the most commonly involved area (89.74%). All cases involved aggressive infections causing high fever and skin necrosis.
- Treatment included aggressive resuscitation, antibiotics, serial debridement of dead tissue, vacuum-assisted closure dressings, and reconstruction with skin grafts or flaps.
- Outcomes included a mean hospital stay of 33
This document describes a case of Fournier's gangrene in a 43-year-old man. The patient presented with flu-like symptoms but upon examination was found to have necrotic scrotal tissue with surrounding erythema and crepitus, indicating necrotizing fasciitis. Treatment for Fournier's gangrene requires aggressive antibiotic therapy, early and repeated surgical debridement of necrotic tissue, and wound care. Scores like LRINEC and FGSI can help predict patient prognosis and risk of mortality from this rare but life-threatening infection.
The document discusses liver anatomy, injuries, and management approaches. It provides details on:
1) The surface anatomy and blood supply of the liver.
2) Common causes and presentations of liver injuries including blunt trauma, penetrating trauma, and associated injuries.
3) Classification systems for grading liver injuries based on CT imaging findings.
4) Treatment approaches including non-operative management with observation for lower grade injuries or angioembolization for bleeding, and operative management using packing, Pringle maneuver, and resection for higher grade or unstable injuries.
Fournier's gangrene is a necrotizing fasciitis of the genital region that is usually polymicrobial in nature. It is more common in males ages 30-60 and risk factors include diabetes, alcoholism, malignancy, and immunosuppression. The infection spreads rapidly in fascial planes due to bacterial enzymes and can cause tissue death. Treatment involves aggressive surgical debridement and broad spectrum antibiotics. Complications can include organ failure, shock, and death if not treated promptly.
Testicular torsion refers to twisting of the spermatic cord and loss of blood supply to the testicle. It is a urological emergency as early diagnosis and treatment are needed to save the testicle. Ultrasound with Doppler is the primary imaging method and shows absent or decreased blood flow in the affected testicle compared to the normal side. Prompt surgical detorsion and orchioplexy are the definitive treatments.
Fournier's gangrene is a necrotizing fasciitis of the genital region that can be caused by various urogenital, anorectal, cutaneous or other infections. It is characterized by pain, swelling and skin necrosis, and can progress rapidly without treatment. The infection involves multiple types of bacteria and causes tissue death through vascular thrombosis. Aggressive surgical debridement and broad-spectrum antibiotics are needed to treat the infection and prevent high mortality rates.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
The document discusses the anatomy and diagnostic evaluation of prostate cancer. It describes the prostate as a walnut-sized gland located below the bladder and surrounding the urethra. The primary function is to produce seminal fluid. Diagnostic workup involves PSA levels, digital rectal exam, prostate biopsy and various imaging modalities like CT, MRI, bone scan and PSMA PET/CT to stage disease extent and metastasis. Gleason scoring is used to grade prostate cancer based on architectural patterns seen on biopsy.
This document describes a case of Fournier's gangrene in a 43-year-old man. The patient presented with flu-like symptoms but upon examination was found to have necrotic scrotal tissue with surrounding erythema and crepitus, indicating necrotizing fasciitis. Treatment for Fournier's gangrene requires aggressive antibiotic therapy, early and repeated surgical debridement of necrotic tissue, and wound care. Scores like LRINEC and FGSI can help predict patient prognosis and risk of mortality from this rare but life-threatening infection.
The document discusses liver anatomy, injuries, and management approaches. It provides details on:
1) The surface anatomy and blood supply of the liver.
2) Common causes and presentations of liver injuries including blunt trauma, penetrating trauma, and associated injuries.
3) Classification systems for grading liver injuries based on CT imaging findings.
4) Treatment approaches including non-operative management with observation for lower grade injuries or angioembolization for bleeding, and operative management using packing, Pringle maneuver, and resection for higher grade or unstable injuries.
Fournier's gangrene is a necrotizing fasciitis of the genital region that is usually polymicrobial in nature. It is more common in males ages 30-60 and risk factors include diabetes, alcoholism, malignancy, and immunosuppression. The infection spreads rapidly in fascial planes due to bacterial enzymes and can cause tissue death. Treatment involves aggressive surgical debridement and broad spectrum antibiotics. Complications can include organ failure, shock, and death if not treated promptly.
Testicular torsion refers to twisting of the spermatic cord and loss of blood supply to the testicle. It is a urological emergency as early diagnosis and treatment are needed to save the testicle. Ultrasound with Doppler is the primary imaging method and shows absent or decreased blood flow in the affected testicle compared to the normal side. Prompt surgical detorsion and orchioplexy are the definitive treatments.
Fournier's gangrene is a necrotizing fasciitis of the genital region that can be caused by various urogenital, anorectal, cutaneous or other infections. It is characterized by pain, swelling and skin necrosis, and can progress rapidly without treatment. The infection involves multiple types of bacteria and causes tissue death through vascular thrombosis. Aggressive surgical debridement and broad-spectrum antibiotics are needed to treat the infection and prevent high mortality rates.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
The document discusses the anatomy and diagnostic evaluation of prostate cancer. It describes the prostate as a walnut-sized gland located below the bladder and surrounding the urethra. The primary function is to produce seminal fluid. Diagnostic workup involves PSA levels, digital rectal exam, prostate biopsy and various imaging modalities like CT, MRI, bone scan and PSMA PET/CT to stage disease extent and metastasis. Gleason scoring is used to grade prostate cancer based on architectural patterns seen on biopsy.
This document discusses treatment options for urinary bladder carcinoma. It covers non-muscle invasive bladder cancer (NMIBC), muscle invasive bladder cancer (MIBC), and metastatic disease. For NMIBC, transurethral resection of bladder tumor (TURBT) followed by intravesical immunotherapy like BCG is recommended. For MIBC, radical cystectomy with pelvic lymphadenectomy and urinary diversion is the standard treatment. Neoadjuvant chemotherapy may improve survival for MIBC. Adjuvant chemotherapy is recommended for high-risk MIBC following cystectomy.
This document provides information about orchitis, including its causes, symptoms, diagnosis, and treatment. Orchitis is an inflammation of the testicles that is usually caused by a virus like mumps or bacteria that spreads from an associated epididymitis. Common symptoms include pain and tenderness in the testicles and scrotum. Diagnosis involves examination of the testicles and scrotum along with potential laboratory tests. While viral orchitis cannot be cured, it will resolve on its own. Bacterial orchitis is treated with antibiotics and anti-inflammatory medications.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
Strangulated inguinal hernias occur when herniated tissue becomes trapped within the hernia sac, cutting off blood flow. This can lead to tissue death. Symptoms include swelling, pain, and signs of bowel obstruction. Diagnosis is usually made through surgical exploration, which may involve bowel resection. While tension-free mesh repairs have been successfully used in strangulated hernias, non-mesh techniques are generally preferred due to the risk of mesh infection in contaminated fields. Proper surgical technique and mesh choice can help reduce infection risks for tension-free repairs in strangulated hernias.
Pancreatic carcinoma ranks 13th in incidence worldwide but 8th as a cause of cancer death due to its poor prognosis. The majority of pancreatic cancers originate in the head of the pancreas. Clinical presentation is often nonspecific with weight loss, abdominal pain, and jaundice being common. Diagnosis relies on imaging such as CT, MRI, and EUS along with blood markers like CA19-9. Staging determines resectability and guides treatment, which may include surgery, chemotherapy, and radiation therapy. Prognosis remains poor even with treatment due to late stage at diagnosis and high rate of recurrence.
This document summarizes renal cell carcinoma (RCC), the most common type of kidney cancer. Key points include:
- RCC originates in the renal cortex and arises mostly from the upper pole of the kidney.
- Common subtypes include clear cell, papillary, and chromophobe carcinomas.
- Risk factors include male sex, older age, smoking, obesity, and genetic conditions like von Hippel-Lindau syndrome.
- Symptoms may include hematuria, flank pain, and palpable flank mass. Imaging like CT and MRI are used to diagnose and stage disease.
- Treatment depends on stage but typically involves surgical removal (radical or partial nephrectomy
Acute mesenteric ischemia is a life-threatening condition caused by interrupted blood flow to the intestines. It has a high mortality rate of 60-80% if not treated promptly. The document discusses the definition, causes, clinical presentation, diagnostic tests and management of acute mesenteric ischemia. Key diagnostic tests include bloodwork, abdominal imaging like CT angiography and angiography. Treatment involves fluid resuscitation, antibiotics, stopping vasoconstrictors, and often emergency surgery to revascularize the intestines or resect non-viable bowel segments. Prompt diagnosis and treatment are critical given the rapid progression of intestinal tissue damage from ischemia.
This document provides information about prolapse of the rectum (rectal prolapse). It discusses the embryology, anatomy, physiology, etiology, clinical features, diagnosis and differential diagnosis of rectal prolapse. Some key points:
- Rectal prolapse is the circumferential descent of the rectum through the anus, either partially (mucosa and submucosa protrude) or completely (full thickness protrusion).
- Risk factors include straining from constipation/diarrhea, pregnancy, prior operations, and neurological/psychiatric conditions.
- Physiologically, it can cause fecal incontinence due to internal sphincter relaxation or damage. Reduction
This document discusses bladder outlet obstruction (BOO) and its causes such as benign prostatic hyperplasia (BPH). It describes the primary and long term effects of BOO on the bladder, including decreased urinary flow rates and increased voiding pressures. For BPH, it notes the causes include hyperplasia of the prostate gland that typically begins in the third decade. The document outlines the diagnosis, evaluation and treatment of BOO, including medical management with medications like alpha blockers and 5-alpha reductase inhibitors, as well as surgical treatments like transurethral resection of the prostate (TURP).
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
This document provides information about perianal abscesses including their etiology, pathogenesis, classification, clinical presentation, investigations, and management. Anorectal abscesses are infections of the soft tissues around the anus that form abscess cavities. They commonly originate from infections of anal glands. Abscesses are usually drained surgically with antibiotics added for immunosuppressed individuals. The type of drainage depends on the abscess classification. While some advocate primary fistulotomy, others prefer delayed fistulotomy after initial incision and drainage to avoid unnecessary procedures.
Carcinoma of the prostate is the most commonly diagnosed cancer and second leading cause of cancer death in men. Risk increases with age and family history. It often metastasizes to bones and lymph nodes. Diagnosis involves elevated PSA levels, abnormal digital rectal exam, biopsy. Staging uses the TNM system - early stages are limited to the prostate while advanced stages have spread outside the prostate. Gleason scoring evaluates microscopic patterns to determine tumor grade and aggressiveness. Treatment depends on tumor stage, grade and patient health.
This document discusses the management of gallbladder cancer. It covers diagnosis, staging, and surgical treatment approaches based on tumor stage. For early stage T1a tumors found incidentally after cholecystectomy, simple cholecystectomy may be adequate. For T1b and T2 tumors, radical resection including lymph node dissection is recommended due to higher risk of residual disease and lymph node involvement. For locally advanced T3/T4 or node positive cancers, radical surgery with hepatic resection or multi-organ resection is supported, though morbidity and mortality are high; N2 node involvement carries a poor prognosis. Staging laparoscopy is important to identify unresectable disease not apparent on imaging.
Liver abscesses can be pyogenic (caused by bacteria), amoebic (caused by Entamoeba histolytica), or fungal. Pyogenic liver abscesses are most commonly located in the right lobe due to blood flow patterns and are usually caused by gram-negative bacteria like E. coli. Patients present with fever, right upper quadrant pain, hepatomegaly, and diarrhea in some cases of amoebic abscess. Diagnosis involves blood tests, imaging like CT or ultrasound, and abscess fluid culture. Treatment is drainage of pus combined with antibiotics, usually percutaneous catheter drainage guided by imaging. For amoebic abscess, metronidazole is usually
This document provides an overview of bladder anatomy, function, and bladder outlet obstruction. It describes the key parts of the bladder including relations to other organs. Normal micturition and factors that assist storage are explained. Causes of bladder outlet obstruction include anatomical and functional issues. Common symptoms include hesitancy, weak stream, and urinary tract infections. Investigations help locate the site of obstruction and assess kidney and bladder function.
This document outlines a seminar plan on carcinoma of the pancreas presented by Dr. Jyotindra Singh. The seminar will cover topics such as the anatomy and surgical anatomy of the pancreas, pancreatic tumors, modes of presentation, pre-operative workup, various surgeries and surgical videos, recent updates, studies and trials, and a take home message. The seminar introduction discusses that carcinoma of the exocrine pancreas accounts for over 90% of pancreatic tumors and remains an oncologic challenge with a 5-year survival rate of 3%.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
RIGHT ILIAC FOSSA LUMP, WITH SPECIAL REFERENCE TO RIGHT COLONIC CANCERArkaprovo Roy
This document discusses potential causes of masses in the right iliac fossa, including appendicular abscess, appendicular mass, ileocecal tuberculosis, and carcinoma of the caecum. It provides characteristics of some common right iliac fossa masses like appendicular masses being tender, soft to firm, and having ill-defined borders, while ileocecal tuberculosis masses are firm to hard and highly placed. The document also reviews colon carcinoma risks such as aging, hereditary factors, and diet high in animal fat or low in fiber, as well as the pathogenesis involving mutations in microsatellite sequences regulating cell growth.
Testicular torsion is a urological emergency caused by twisting of the spermatic cord, cutting off blood supply to the testicle. It most commonly affects adolescent boys and young men under age 25. Without prompt surgical intervention to untwist the cord within 6-12 hours, the testicle will become necrotic. Diagnosis involves physical exam findings like a high-riding, swollen testicle with absent cremasteric reflex as well as Doppler ultrasound showing reduced or absent blood flow. Immediate orchiopexy is needed to save the testicle from necrosis and allow for potential future fertility.
The document discusses gastric perforation, beginning with the anatomy of the stomach and its layers. It then addresses the epidemiology of gastric perforation, noting that males have higher rates and risk factors include H. pylori infection, NSAID use, smoking, and alcohol consumption. The pathophysiology and signs/symptoms are explained, along with diagnostic tools such as abdominal x-rays and CT scans. Surgical treatments like omental patching, vagotomy, and gastrojejunostomy are covered. Finally, complications and prognosis are summarized.
FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY INSTITUTIONAnil Haripriya
Fournier’s gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals is now changing its pattern. Both genders can be affected and the mortality is still high (around10%). The clinical presentation in many patients in early stage may not be prominent. Thus rapid and accurate diagnosis is must for prompt treatment. Extensive surgical debridement and broad spectrum intravenous antibiotic remains the mainstay of treatment in order to reduce the morbidity and mortality.
Management of Fournier’s Gangrene in a Low Resource Settingasclepiuspdfs
external genitalia and perineum. Although the condition is rare in absolute terms, over 1726 cases have been reported in English literature, with a male/female ratio of 10:1. There have been 502 cases from Africa, which ranks second to the USA/Canada. At present, there is only one published literature on the management of FG in Liberia. Objective: This study highlig hts the late presentation and the challenges in the management of FG at the John F. Kennedy Medical Center. Methodology: This is a retrospective study of 30 patients with FG who were admitted and managed by our division of urology, from January 2018 to May 2019. The patient’s records were retrieved and reviewed for age, sex, onset of disease, sites of the disease, management, duration of stay, and outcome. The frequency and percentage of various parameters were displayed in tables.
This document discusses treatment options for urinary bladder carcinoma. It covers non-muscle invasive bladder cancer (NMIBC), muscle invasive bladder cancer (MIBC), and metastatic disease. For NMIBC, transurethral resection of bladder tumor (TURBT) followed by intravesical immunotherapy like BCG is recommended. For MIBC, radical cystectomy with pelvic lymphadenectomy and urinary diversion is the standard treatment. Neoadjuvant chemotherapy may improve survival for MIBC. Adjuvant chemotherapy is recommended for high-risk MIBC following cystectomy.
This document provides information about orchitis, including its causes, symptoms, diagnosis, and treatment. Orchitis is an inflammation of the testicles that is usually caused by a virus like mumps or bacteria that spreads from an associated epididymitis. Common symptoms include pain and tenderness in the testicles and scrotum. Diagnosis involves examination of the testicles and scrotum along with potential laboratory tests. While viral orchitis cannot be cured, it will resolve on its own. Bacterial orchitis is treated with antibiotics and anti-inflammatory medications.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
Strangulated inguinal hernias occur when herniated tissue becomes trapped within the hernia sac, cutting off blood flow. This can lead to tissue death. Symptoms include swelling, pain, and signs of bowel obstruction. Diagnosis is usually made through surgical exploration, which may involve bowel resection. While tension-free mesh repairs have been successfully used in strangulated hernias, non-mesh techniques are generally preferred due to the risk of mesh infection in contaminated fields. Proper surgical technique and mesh choice can help reduce infection risks for tension-free repairs in strangulated hernias.
Pancreatic carcinoma ranks 13th in incidence worldwide but 8th as a cause of cancer death due to its poor prognosis. The majority of pancreatic cancers originate in the head of the pancreas. Clinical presentation is often nonspecific with weight loss, abdominal pain, and jaundice being common. Diagnosis relies on imaging such as CT, MRI, and EUS along with blood markers like CA19-9. Staging determines resectability and guides treatment, which may include surgery, chemotherapy, and radiation therapy. Prognosis remains poor even with treatment due to late stage at diagnosis and high rate of recurrence.
This document summarizes renal cell carcinoma (RCC), the most common type of kidney cancer. Key points include:
- RCC originates in the renal cortex and arises mostly from the upper pole of the kidney.
- Common subtypes include clear cell, papillary, and chromophobe carcinomas.
- Risk factors include male sex, older age, smoking, obesity, and genetic conditions like von Hippel-Lindau syndrome.
- Symptoms may include hematuria, flank pain, and palpable flank mass. Imaging like CT and MRI are used to diagnose and stage disease.
- Treatment depends on stage but typically involves surgical removal (radical or partial nephrectomy
Acute mesenteric ischemia is a life-threatening condition caused by interrupted blood flow to the intestines. It has a high mortality rate of 60-80% if not treated promptly. The document discusses the definition, causes, clinical presentation, diagnostic tests and management of acute mesenteric ischemia. Key diagnostic tests include bloodwork, abdominal imaging like CT angiography and angiography. Treatment involves fluid resuscitation, antibiotics, stopping vasoconstrictors, and often emergency surgery to revascularize the intestines or resect non-viable bowel segments. Prompt diagnosis and treatment are critical given the rapid progression of intestinal tissue damage from ischemia.
This document provides information about prolapse of the rectum (rectal prolapse). It discusses the embryology, anatomy, physiology, etiology, clinical features, diagnosis and differential diagnosis of rectal prolapse. Some key points:
- Rectal prolapse is the circumferential descent of the rectum through the anus, either partially (mucosa and submucosa protrude) or completely (full thickness protrusion).
- Risk factors include straining from constipation/diarrhea, pregnancy, prior operations, and neurological/psychiatric conditions.
- Physiologically, it can cause fecal incontinence due to internal sphincter relaxation or damage. Reduction
This document discusses bladder outlet obstruction (BOO) and its causes such as benign prostatic hyperplasia (BPH). It describes the primary and long term effects of BOO on the bladder, including decreased urinary flow rates and increased voiding pressures. For BPH, it notes the causes include hyperplasia of the prostate gland that typically begins in the third decade. The document outlines the diagnosis, evaluation and treatment of BOO, including medical management with medications like alpha blockers and 5-alpha reductase inhibitors, as well as surgical treatments like transurethral resection of the prostate (TURP).
The document summarizes key anatomical and clinical aspects of the rectum:
1. The rectum is 12-15 cm long, located in the pelvis behind the lower sacrum and coccyx. It has three sections with varying peritoneal coverage and blood supply.
2. Rectal cancer is the third most common cancer in the US. Risk factors include diet, family history, and conditions like ulcerative colitis. Symptoms often include changes in bowel habits or bleeding.
3. Treatment involves surgery like low anterior resection or abdominoperineal resection. Total mesorectal excision improves outcomes by completely removing the mesorectum and reducing local recurrence rates.
This document provides information about perianal abscesses including their etiology, pathogenesis, classification, clinical presentation, investigations, and management. Anorectal abscesses are infections of the soft tissues around the anus that form abscess cavities. They commonly originate from infections of anal glands. Abscesses are usually drained surgically with antibiotics added for immunosuppressed individuals. The type of drainage depends on the abscess classification. While some advocate primary fistulotomy, others prefer delayed fistulotomy after initial incision and drainage to avoid unnecessary procedures.
Carcinoma of the prostate is the most commonly diagnosed cancer and second leading cause of cancer death in men. Risk increases with age and family history. It often metastasizes to bones and lymph nodes. Diagnosis involves elevated PSA levels, abnormal digital rectal exam, biopsy. Staging uses the TNM system - early stages are limited to the prostate while advanced stages have spread outside the prostate. Gleason scoring evaluates microscopic patterns to determine tumor grade and aggressiveness. Treatment depends on tumor stage, grade and patient health.
This document discusses the management of gallbladder cancer. It covers diagnosis, staging, and surgical treatment approaches based on tumor stage. For early stage T1a tumors found incidentally after cholecystectomy, simple cholecystectomy may be adequate. For T1b and T2 tumors, radical resection including lymph node dissection is recommended due to higher risk of residual disease and lymph node involvement. For locally advanced T3/T4 or node positive cancers, radical surgery with hepatic resection or multi-organ resection is supported, though morbidity and mortality are high; N2 node involvement carries a poor prognosis. Staging laparoscopy is important to identify unresectable disease not apparent on imaging.
Liver abscesses can be pyogenic (caused by bacteria), amoebic (caused by Entamoeba histolytica), or fungal. Pyogenic liver abscesses are most commonly located in the right lobe due to blood flow patterns and are usually caused by gram-negative bacteria like E. coli. Patients present with fever, right upper quadrant pain, hepatomegaly, and diarrhea in some cases of amoebic abscess. Diagnosis involves blood tests, imaging like CT or ultrasound, and abscess fluid culture. Treatment is drainage of pus combined with antibiotics, usually percutaneous catheter drainage guided by imaging. For amoebic abscess, metronidazole is usually
This document provides an overview of bladder anatomy, function, and bladder outlet obstruction. It describes the key parts of the bladder including relations to other organs. Normal micturition and factors that assist storage are explained. Causes of bladder outlet obstruction include anatomical and functional issues. Common symptoms include hesitancy, weak stream, and urinary tract infections. Investigations help locate the site of obstruction and assess kidney and bladder function.
This document outlines a seminar plan on carcinoma of the pancreas presented by Dr. Jyotindra Singh. The seminar will cover topics such as the anatomy and surgical anatomy of the pancreas, pancreatic tumors, modes of presentation, pre-operative workup, various surgeries and surgical videos, recent updates, studies and trials, and a take home message. The seminar introduction discusses that carcinoma of the exocrine pancreas accounts for over 90% of pancreatic tumors and remains an oncologic challenge with a 5-year survival rate of 3%.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
RIGHT ILIAC FOSSA LUMP, WITH SPECIAL REFERENCE TO RIGHT COLONIC CANCERArkaprovo Roy
This document discusses potential causes of masses in the right iliac fossa, including appendicular abscess, appendicular mass, ileocecal tuberculosis, and carcinoma of the caecum. It provides characteristics of some common right iliac fossa masses like appendicular masses being tender, soft to firm, and having ill-defined borders, while ileocecal tuberculosis masses are firm to hard and highly placed. The document also reviews colon carcinoma risks such as aging, hereditary factors, and diet high in animal fat or low in fiber, as well as the pathogenesis involving mutations in microsatellite sequences regulating cell growth.
Testicular torsion is a urological emergency caused by twisting of the spermatic cord, cutting off blood supply to the testicle. It most commonly affects adolescent boys and young men under age 25. Without prompt surgical intervention to untwist the cord within 6-12 hours, the testicle will become necrotic. Diagnosis involves physical exam findings like a high-riding, swollen testicle with absent cremasteric reflex as well as Doppler ultrasound showing reduced or absent blood flow. Immediate orchiopexy is needed to save the testicle from necrosis and allow for potential future fertility.
The document discusses gastric perforation, beginning with the anatomy of the stomach and its layers. It then addresses the epidemiology of gastric perforation, noting that males have higher rates and risk factors include H. pylori infection, NSAID use, smoking, and alcohol consumption. The pathophysiology and signs/symptoms are explained, along with diagnostic tools such as abdominal x-rays and CT scans. Surgical treatments like omental patching, vagotomy, and gastrojejunostomy are covered. Finally, complications and prognosis are summarized.
FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY INSTITUTIONAnil Haripriya
Fournier’s gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals is now changing its pattern. Both genders can be affected and the mortality is still high (around10%). The clinical presentation in many patients in early stage may not be prominent. Thus rapid and accurate diagnosis is must for prompt treatment. Extensive surgical debridement and broad spectrum intravenous antibiotic remains the mainstay of treatment in order to reduce the morbidity and mortality.
Management of Fournier’s Gangrene in a Low Resource Settingasclepiuspdfs
external genitalia and perineum. Although the condition is rare in absolute terms, over 1726 cases have been reported in English literature, with a male/female ratio of 10:1. There have been 502 cases from Africa, which ranks second to the USA/Canada. At present, there is only one published literature on the management of FG in Liberia. Objective: This study highlig hts the late presentation and the challenges in the management of FG at the John F. Kennedy Medical Center. Methodology: This is a retrospective study of 30 patients with FG who were admitted and managed by our division of urology, from January 2018 to May 2019. The patient’s records were retrieved and reviewed for age, sex, onset of disease, sites of the disease, management, duration of stay, and outcome. The frequency and percentage of various parameters were displayed in tables.
This document summarizes a study of 233 cases of abdominal tuberculosis treated at a hospital in Pakistan from 2003-2008. Some key findings include:
- The average age was 28 years and most patients were from poor families.
- The most common presentation was acute abdomen (67%), requiring emergency surgery. Common surgical findings included intestinal strictures (69%).
- Most cases involved the ileocecal region and presented as intestinal obstructions.
- The majority of cases were considered primary abdominal tuberculosis, though some had a history of pulmonary TB.
- Most patients required hospitalization, with an average stay of 19.5 days. The in-hospital mortality rate was 2.1%.
A RETROSPECTIVE ANALYSIS IN TERTIARY HOSPITAL FOR SURGICAL SITE INFECTIONS AF...indexPub
Objectives: to know about percentage of patients getting wound infection and commonly grown bacteria in emergency laparotomy incisions. Summary: Surgical site infections are very high in developing countries. Infections at surgical sites leads to delayed discharge from hospital increased cost of treatment to either government or patient themselves.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
—Fungal organisms are ubiquitous. A common location for these organisms to enter the human body is through the external acoustic canal, oral cavity, and pharynx and sino-nasal cavity. A study was conducted with clinical and mycological analysis of various fungal infections in ENT. Patients suspected for having fungal infections attending at Department of ENT were interrogated and analysed. Swabs collected from these cases were sent for direct microscopy by KOH mounts for fungal examination and fungal culture. Microbiological confirmed 100 cases were finally included in the study Histopathological examination of nasal mass and polyposis was also done. It was observed in this present study otomycosis was most common and accounted for 84% of the total cases followed by candidiasis in oral cavity and pharynx in 9%, allergic fungal rhinosinusitis in 4% and rhinosporidiosis in 3%. Aspergillus niger was that most common fungus isolated in 61% cases, followed by Candida albicans in 24% cases, Aspergillus flavus in 9% cases, Aspergillus fumigatus and Rhinosporodium seeberi in 3% cases each. All the cases of fungal infection of oral cavity and oropharynx were due to Candida albicans.
Prevalence of Hpv Infection in the Lekoumou and Niari Departments (Congo Braz...JohnJulie1
This study aimed to determine the prevalence of HPV infection in women in the Lekoumou and Niari departments of Congo Brazzaville. The researchers collected samples from 100 women aged 16-73 and tested them for HPV. They found an overall HPV prevalence of 29%. Certain demographic factors like age, education level, marital status, age of first intercourse, number of sexual partners and parity did not show statistically significant associations with HPV infection status. The study provides baseline data on HPV prevalence in the region that can inform future cervical cancer prevention efforts.
Prevalence of Hpv Infection in the Lekoumou and Niari Departments (Congo Braz...NainaAnon
This study aimed to determine the prevalence of HPV infection in women in the Lekoumou and Niari departments of Congo Brazzaville. The researchers collected samples from 100 women aged 16-73 and tested them for HPV. They found an overall HPV prevalence of 29%, with the highest rates (58.3%) in women over 50. No significant associations were found between HPV infection and factors like education level, age of first intercourse, number of sexual partners, or number of pregnancies. The study provides baseline data on HPV prevalence in these regions of Congo to help guide cervical cancer prevention efforts.
Clinics of Oncology | Oncology Journals | Open Access JournaEditorSara
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We carried out a descriptive and cross-sectional study over a period of 7 months from January to July 2019 in the department of Lekoumou. 100 women ranging in age from 16 to 73 years old. The variables studied were as follows: age, marital status, level of education, risk factors for the onset of HPV infection, age at first sexual intercourse, number of sexual partners, parity, gesture. The multivariate analysis was done between age, number of level of instruction, parity, age of first sexual intercourse and number of sexual Partners. The statistical analysis and the data processing were carried out by the Excel 2016 software and the graph pad prism version 5 software. The statistical test used was the chi-square test.
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This document lists the names and specialties of 217 reviewers for the Khyber Medical University Journal (KMUJ). The reviewers come from various medical and surgical specialties and are located in Pakistan as well as other countries including the United States, United Kingdom, Saudi Arabia, and others. Their specialties span fields including internal medicine, surgery, psychiatry, obstetrics/gynecology, cardiology, and many others.
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Fournier's gangrene
1. JPMI VOL. 31 NO. 4 371
FOURNIER’S GANGRENE: MANAGEMENT EXPERIENCE
OF 39 CASES
Ikramullah1
, Irfan Ullah2
, Qaisar Iqbal3
, Muhammad Saaiq4
ORIGINAL ARTICLE
INTRODUCTION
Fournier’s gangrene is an aggressive soft-tissue in-
fection that often leads to significant loss of skin and
subcutaneous tissue in the perineal region. This acute
fulminating necrotizing infection usually inflicts individ-
uals with compromised immunity secondary to a variety
of conditions. For instance those with severe nutritional
deficiencies, immunosuppressant therapy, diabetes, in-
flammatory conditions of the perineum, urinary incon-
tinence, fecal contamination and poor hygienic status.
It is usually rapidly progressive and potentially fatal1-3
.
This disastrous condition results from mixed aerobic
and anaerobic bacterial infection. The compromised im-
munity of the host provides a favourable flourishing en-
vironment for the bacteria to initiate the infection and
rapidly promote the spread of the disease. Owing to the
polymicrobial nature of the infection, the causative bac-
teria act synergistically to produce a variety of enzymes
which promote their rapid multiplication as well as dra-
matic spread of the infection along the various tissue
planes. The organisms involved are the usual bacterial
flora of the perineal skin. Among these, the common
microbes are the anaerobic species, bacteriodes, clos-
tridial species and streptococci4,5
.
Fournier’s gangrene is a serious condition of grave
prognosis. The outcome depends not only on the se-
verity of the illness and a variety of host characteristics
but more importantly on the adequacy of appropriately
instituted supportive and surgical management6
.
In Fournier’s gangrene, typically only the scrotum is
involved initially, which if left untreated results in spread
of the fasciitis that culminates in exposure of the testes.
The presentation is usually of sudden onset. One hall-
mark feature is the very irritating odour that emanates
from the affected wounds. The inflammatory process
can rapidly spread to involve the entire scrotum, penile
skin, pubic area and the anterior abdominal wall as far
as the clavicle7-10
.
This article may be cited as: Ikramullah, Ullah I, Iqbal Q, Saaiq M. Fournier’s gangrene: Management experience
of 39 cases. J Postgrad Med Inst 2017; 31(4): 371-7.
ABSTRACT
Objective: To determine the clinical presentation and management outcome
of Fournier’s gangrene.
Methodology: This descriptive case series was carried out at the Department
of Urology, Lady Reading Hospital, Peshawar over a 5-years period. All patients
with Fournier’s gangrene were included. The socio-demographic profile of the
patients, area of involvement, underlying co-morbids, survival versus death,
length of hospital stay and various surgical procedures undertaken were all
recorded on a proforma.
Results: Out of 39 patients, 89.74% (n=35) were males while 10.25% (n=4) were
females. The age range was 17-63 years with a mean of 46.20 ±13.32 years. Poor
general health/ malnutrition in 82.05% patients (n=32) was the commonest un-
derlying cause. Scrotum (n=35; 89.74%) was the most frequently involved body
area. The hospital stay was 7-63 days with a mean of 33.46 ±13.79 days. The
interventions undertaken included serial radical debridements (n=39; 100%),
split thickness skin grafts (n=19; 48.71%), direct closure of scrotal defects (n=9;
23.07%) and flaps (n=4; 10.25%). There were 07 mortalities (17.94% ).
Conclusion: Fournier’s gangrene causes significant morbidity, hospitalization
and mortality in our population. Necrotizing fasciitis of the scrotum or perine-
um is the usual presentation. Aggressive resuscitation and surgical excision of
the dead tissues followed by meticulous care of the surviving patient renders
the resultant defects manageable with skin grafts and flaps.
Key Words: Fournier’s gangrene, Vacuum assisted closure, Skin graft
1
Department of Urology,
Lady Reading Hospital, Pesha-
war-Pakistan.
2
Department of Plastic Sur-
gery, Lady Reading Hospital,
Peshawar-Pakistan.
3
Institute of Kindy Diseases,
Hayatabad Medical Complex,
Peshawar-Pakistan.
4
Department of Plastic
surgery, Pakistan Institute
of Medical Sciences, Islam-
abad-Pakistan.
Address for Correspondence:
Dr. Irfan Ullah
Assistant Professor,
Department of Plastic Surgery,
Lady Reading Hospital, Pesha-
war – Pakistan.
E-mail: drirfann@gmail.com
Date Received:
March 21, 2017
Date Revised:
October 27, 2017
Date Accepted:
November 06, 2017
2. JPMI VOL. 31 NO. 4 372
FOURNIER’S GANGRENE: MANAGEMENT EXPERIENCE OF 39 CASES
Fournier’s gangrene afflicts our population. Majority
of our patients present in the late stage. The present
study was carried out to document its presentation and
management outcome among our patients.
METHODOLOGY
It was a descriptive case series. It was undertaken at
the Department of Urology, Lady Reading Hospital, Pe-
shawar over a period of 5-years spanning from January
01, 2012 to December 31, 2016. All patients of either
gender and all ages who presented with Fournier’s gan-
grene and were managed at our department were in-
cluded in the study. Exclusion criteria included patients
who refused consent to be part of the study. Written
informed consent was taken. The study protocol con-
formed to the Declaration of Helsinki of 1975, as re-
vised in 2013. We ensured anonymity of the recruited
patients.
Initial evaluation was made by history, physical ex-
amination and all ancillary investigations. Blood com-
plete picture with differential counts, serum electro-
lytes, urea, creatinine, blood glucose, arterial blood
gases, blood cultures, urine cultures, coagulation pro-
file, serum fibrinogen, FDPs (fibrin degradation product)
levels, tissue cultures of the wound for microbial growth
and quantitative bacterial counts. The laboratory risk in-
dicator for necrotizing fasciitis (LRINEC) score was mea-
sured by performing CRP (C-reactive protein) levels, to-
tal white cell count, haemoglobin level, serum sodium,
serum creatinine and blood glucose levels. (Table 1)
All the patients were hospitalized and were aggres-
sively managed for Fournier’s gangrene. Large bore in-
travenous cannulae and Foley catheter was passed at
presentation among all patients. Aggressive resuscita-
tion was done to restore fluid and electrolyte balance.
Blood transfusions were done where indicated. Broad
spectrum antibiotics (i.e. triple therapy with third gen-
eration cephalosporins, metronidazole and penicillin)
were started empirically. Diabetes mellitus and any oth-
er underlying co-morbid condition was treated as per
standard protocols.
Urgent serial radical excisions of the dead tissues
were performed followed by application of vacuum
assisted closure (VAC) dressings which were changed
every third day and continued for 2-3 weeks. Once
the wounds had a quantitative bacterial count of <105
organisms per gram of tissue, definitive reconstruc-
tion with split thickness skin grafts (STSG) or flaps was
undertaken. The patients were discharged home upon
complete recovery with further regular follow up for
three months.
The socio-demographic profile of the patients, ana-
tomic site of involvement and any underlying co-mor-
bidities were recorded. For the purpose of the study,
the economic status of the patients was categorized as
poor (if the average monthly income of the family was
<Rs.15,000), satisfactory (if the income was >Rs.15,000
to Rs. 50,000) and good if it was >Rs. 50,000. The out-
come measures recorded were the LRINEC score at
presentation (i.e. the laboratory risk indicator for nec-
rotizing fasciitis), survival versus in-hospital mortality,
hospital stay and the frequency of the various excisional
and subsequent reconstructive procedures instituted. A
proforma was employed for data collection.
Figures 1 through 4(c) show the representative pic-
tures of some of the patients included in this case series.
SPSS (Statistical package for social sciences) version 17
was employed for analyzing the data. Descriptive statis-
tics were calculated for study variables.
RESULTS
A total of 39 patients were included in the study. Out
of these, 89.74% (n=35) were males while 10.25% (n=4)
were females. The patients ranged in age from 17 years
to 63 years with a mean age 46.20 ±13.32 years. The
condition was significantly more frequent among pa-
tients with age over 40 years (74.35%; n=29) than those
with less than 40 years age (25.64%; n=15) (p value
<0.001).
The underlying causes included poor general health/
malnutrition among 82.05% patients (n=32), uncon-
trolled diabetes mellitus among 33.33% patients (n=13),
and post renal transplant immuno-suppression among
7.69% patients (n=3). Economically, majority of the pa-
tients were poor (n=31; 79.48%), followed by satisfacto-
ry (n=5: 12.82%) and good (n=3; 7.69%).
The body areas affected included scrotum (n=35;
89.74%), penis (n=13; 33.33%), pubic area/ lower abdo-
men (n=7; 17.94%) and perineum/labia (n=4; 10.25%).
Of the microbial growths of the wound biopsies,
none yielded monobacterial isolates whereas all were
polybacterial growths. There were three organisms
grown among 32 patients (82.02%), four organisms
were cultured among three patients (7.69%) and five
organisms were grown among four patients (10.25%).
The organisms cultured included varying percentages
of clostridia, E.coli, Klebsiella pneumonia, bacteroides,
corynebacteria, enterobacter, Staphylococcal species,
streptococci and Pseudomonas aeruginosa.
All the patients (n=39; 100%) presented with high
fever, prostration, painful swelling of scrotum/ perine-
um and skin necrosis. The LRINEC score at presentation
was >8 in 58.97% patients (n=23), 8 in 28.20% patients
(n=11), 7 in 7.69% patients (n=3) and 6 in 5.12% pa-
tients (n=2). The length of hospital stay ranged from 7
days to 63 days with a mean of 33.46 ±13.79 days.
The various interventional procedures undertaken
3. JPMI VOL. 31 NO. 4 373
FOURNIER’S GANGRENE: MANAGEMENT EXPERIENCE OF 39 CASES
included serial radical debridements among all patients
(n=39; 100%), followed by meshed split thickness skin
grafts (n=19; 48.71%), direct closure of scrotal defects
(n=9; 23.07%) and various flaps for reconstructing large
defects (n=4; 10.25%). There were seven mortalities in
this case series, constituting an overall mortality rate of
17.94%.
DISCUSSION
Fournier’s gangrene is a sinister infection that pre-
dominantly inflicts our adult male population particu-
larly those aged over 40 years. More frequent involve-
ment of adult males has also been reported by most of
the published literature1-3
.
In our series, majority of the patients presented
Table 1: The laboratory risk indicator for necrotizing fasciitis (LRINEC) score
Variable, Units Score
C-Reactive Protein, mg/L
<150 0
≥150 4
Total White Cell Count, mm3
<15000 0
15000–25000 1
>25000 2
Haemoglobin, g/dL
>13.5 0
11–13.5 1
<11 2
Sodium, meq/L
≥135 0
<135 2
Creatanine, μmol/L
≤141 0
>141 2
Glucose, mmol/L
≤10 0
>10 1
Figure 1: Fournier’s gangrene in a lady with
uncontrolled diabetes mellitus, demonstrat-
ing characteristic involvement of the female
perineum and genitalia
Figure 2 (a): Fournier’s gangrene in a male
patient demonstrating characteristic exposure
of the testes
4. JPMI VOL. 31 NO. 4 374
FOURNIER’S GANGRENE: MANAGEMENT EXPERIENCE OF 39 CASES
Figure 2 (b): Same patient as in figure 2(a)
following serial radical debridements and VAC
dressings rendering the wound suitable to be
closed directly
Figure 3 (c): Same patient as in figures 3(a &
b), the penis was grafted with a sheet of thick
STSG to prevent secondary contracture of the
graft and hence shortening of the phallus. The
testes were grafted with meshed STSG to allow
any exudates to egress
Figure 3 (a): Young patient with Fournier’s gan-
grene with typical loss of the skin cover of the
testes and penis. Serial radical debridements
and VAC dressings have rendered the wounds
graftable
Figure 2 (c): Same patient as in figures 2(a & b),
the scrotal wound was closed directly
Figure 3 (d): Same patient as in figures 3(a, b &
c) on 5th postoperative day with 100% take of
the grafts on penis and testes
Figure 3 (b): Same patient as in figure 3(a),
wounds ready for skin grafting.
5. JPMI VOL. 31 NO. 4 375
FOURNIER’S GANGRENE: MANAGEMENT EXPERIENCE OF 39 CASES
acutely with various toxic signs and symptoms. Among
these included high grade fever, prostration, painful
swelling of the scrotal area, skin erythema and various
perineal wounds.
In our study we employed the LRINEC score as a di-
agnostic tool and found it very useful. We found that a
score of 8 or more is diagnostic of the condition while
a score of 6 should prompt a strong suspicion of it. Our
observations conform to most of the published litera-
ture11-13
.
Majority of our patients had underlying malnutrition
and belonged to the poor socioeconomic segment of
the population. The peer reviewed literature on Fourni-
er’s gangrene has outlined a variety of predisposing fac-
tors. For instance immune-compromise, diabetes melli-
tus, severe malnutrition, alcohol addiction, extremes of
age, underlying malignancy, steroid therapy and HIV/
AIDS infection. In fact any condition with impaired im-
munity may predispose to the development of Fournier
gangrene. In the West, the emergence of HIV-AIDS into
epidemic proportions has exposed a huge population
at risk for developing Fournier’s gangrene1-3,5,7
.
Among all our male patients, we encountered loss of
the skin and subcutaneous tissue of the scrotum with
variable involvement of other perineal structures. When
the testicular defects involved over 50% surface area
of the scrotum, we employed meshed STSGs for cov-
erage. In fact in Fournier’s gangrene, the testicular skin
sloughs off, however actual testicular involvement usu-
ally does not occur owing to the presence of separate
blood supply to the testes14
. The tunica vaginalis is often
intact and hence skin graft take is usually good once the
wound bed has been suitably prepared for skin grafting.
Eke N15
in his review of a large population of patients
pointed out that the testicular involvement signifies
a possible retroperitoneal or intra-abdominal source
of infection among these patients. We performed or-
chidectomy in none of our patients, however Ayan et
al16
in their study performed orchidectomy more fre-
quently among their patients.
We observed loss of penile skin in 33.33% of our
patients. We managed the penile defects with sheets
Figure 4 (a): Elderly male with Fournier’s gan-
grene involving scrotum, penis, pubic area and
adjacent lower abdomen
Figure 4 (c): Same patient as in figures 4(a & b), some granulation tissues have started ap-
pearing following two VAC dressings each for three days duration
Figure 4 (b): Same patient as in figure 4(a), fol-
lowing radical excision, the wound was initially
managed with several VAC dressings
6. JPMI VOL. 31 NO. 4 376
FOURNIER’S GANGRENE: MANAGEMENT EXPERIENCE OF 39 CASES
of thick STSGs. In fact, similar to the testes, the penis
typically loses its skin cover while the corpora are usu-
ally spared. Thrombosis of the corpus spongiosum and
cavernosum is very rare17
.
Following early and aggressive serial debridements
of all the nonviable tissues, we employed vacuum as-
sisted closure (VAC) dressings among all patients. The
VAC therapy is of considerable help in managing these
difficult wounds. It promotes tissue healing. It removes
exudates, edema fluid and bacteria from the wound,
converts the open wound into a controlled wound,
stimulates vascularization, and prevents further bac-
terial infection of the wound Our current favourable
experience with VAC therapy conforms to many of the
published studies18-20
.
We did primary closure of scrotal wounds if the gan-
grene spared upto 50% of the scrotal skin. In the remain-
der of the patients we employed meshed split thickness
skin graft (STSG) as our workhorse reconstructive tool.
In the published literature STSG is the most favoured
method for scrotal reconstruction and coverage of the
exposed testes. The testes may be sutured together in
the midline to reduce the surface area of the wound and
facilitate closure. The meshed STSGs conform to the ir-
regular surfaces of these defects quite well. The graft
take is typically 100%, provided there is a well-vascular-
ized recipient bed and intact tunica vaginalis.
In addition to the STSGs, the coverage of exposed
testicles may also be performed by using medial thigh
pockets. This latter method involves elevation of the
medial thigh flaps from the two thighs and suturing
them together in the midline. The superficial nature of
the flaps protects the testes from the elevated abdom-
inal temperatures that can adversely affect spermato-
genesis. Understandably there must be soft tissues of
sufficient laxity in the medial thighs for this procedure
to be effective. These flaps provide adequate coverage
but may produce significant contour deformity. This
then necessitates a revisional reconstruction. This sub-
sequent coverage is provided by a variety of flaps such
as the vertical rectus abdominus myocutaneous flap
(VRAM flap), gracilis muscle, or myocutaneous flap, the
posterior thigh flap and pudendal thigh flap21,22
.
In our study we encountered seven mortalities. Eke
N15
in an exhaustive review of 1726 cases of Fournier’s
gangrene reported 16% mortality whereas Pawłowski et
al23
reported a mortality rate of 20%–30%.
We did not employ hyperbaric oxygen therapy (HBO)
in our patients owing to the non availability of this mo-
dality at our hospital. Some published studies23,24
have
however highlighted its role as a very useful adjunct in
managing these patients. The HBO therapy has direct
bactericidal effects on clostridial species while bacterio-
static effects on pseudomonas species.
LIMITATIONS
The strengths and limitations of our study are as fol-
lows. The study spanned over a reasonable period of
time and encompassed large case volume. Among the
limitations include the descriptive nature of the study,
its being based on a single centre data and the short
follow up period of three months.
CONCLUSION
Fournier’s gangrene constitutes a source of signif-
icant morbidity, hospitalization and mortality in our
population. It frequently affects the middle aged males
aged over 40 years. Acute severe systemic illness with
high grade fever, prostration and necrotizing fasciitis
of the scrotum or perineum is the usual presentation
among our patients. Aggressive resuscitation and ur-
gent surgical excision of the dead tissues followed by
meticulous care of the patient renders the resultant de-
fects manageable with skin grafts and flaps. Despite our
best efforts there was a mortality rate of 17.94% in our
patients.
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CONTRIBUTORS
I conceived and designed the format of the study
and collected the data. IU, QI and MS performed the
literature search and participated significantly in the
analysis and interpretation of the results. All the au-
thors participated in writing the manuscript. All of
them critically reviewed, refined and approved the
manuscript. All authors contributed significantly to
the submitted manuscript.
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