Fournier坏疽临床诊断和综合治疗1例报告及文献复习

doi:10.13481/j.1671-587X.20240430

Abstract

Abstract:

Objective To discuss the clinical presentations， diagnosis， and treatment methods of the patients with Fournier’s gangrene， and to enhance the clinicians’ awareness of this condition. Methods The clinical data including symptoms， signs， radiological findings， and surgical outcomes of one patient with Fournier’s gangrene were collected.The relevant literatures were reviewed to summarize the clinical characteristics， diagnosis， and treatment methods for this condition. Results The patient， a 42-year-old male， was admitted because of a history of infection around the perineum， scrotum， and perianal area for 13 d. His medical history included acute myeloid leukemia for 10 months， during which the patient underwent eight chemotherapy sessions in the local hospital. The abdominal CT scan results showed thickened， dense， and turbid soft tissue in the left inguinal area. The complete blood count reuslts showed the white blood cell count was 23.99×10⁹ L^-1. The cultures of wound secretions grew the Escherichiacoli and Proteus mirabilis. The examination results showed there was necrosis of the scrotal skin and skin near the anus on the left buttock； the skin was blackened， hard， and demarcated from the surrounding normal skin with slight purulent exudation and no foul smell. The surrounding skin was significantly swollen and red； the rectal examination results showed no bleeding or fistulas. The patient underwent emergency debridement surgery on the admission day， followed by dressing changes， multiple applications of simplified negative pressure， perineal flap reconstruction， and skin grafting. The patient recovered well with normal function and had no complications. Conclusion Fournier gangrene has acute onset and rapid progression， and the clinical manifestations are non-specific. The range of infection is not consistent with the progression of the disease. The diagnosis mainly depends on intraoperative exploration. Repeated radical surgery is the main treatment. The prognosis of this disease is good， and the recurrence rate is low， although long-term follow-up is still necessary after surgery.

Key words: Fournier’s gangrene, Necrotizing fasciitis, Negative pressure treatment, Perineum, Skin transplantation, Flap reconstruction

CLC Number:

R631

Xiangli KONG,Kai SHI,Xi ZHANG,Yan XUE,Lei HONG,Xiuhang ZHANG. Clinical diagnosis and comprehensive treatment of Fournier’s gangrene: A case report and literature review[J].Journal of Jilin University(Medicine Edition), 2024, 50(4): 1144-1149.

Figures/Tables 4

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References 27

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Variable	Value	Score
Hemoglobin	<110 g?L^-1	2
	110-135 g?L^-1	1
	>135 g?L^-1	0
Total white blood cell count	<15×10³ μL^-1	0
	(15-25)×10³ μL^-1	1
	>25×10³ μL^-1	2
Sodium	<135 mmol?L^-1	2
Creatinine	>1.6 mg?dL^-1	2
Glucose	>180 mg?dL^-1	1
C-reactive protein	>150 mg?L^-1	4

Risk category	LRINEC score	Probability for presence of necrotizing fasciitis
Low	≤5	<50%
Medium	6-7	50%-75%
High	≥8	>75%

Variable	High abnormal value				Normal value	Low abnormal value
Variable	+4	+3	+2	+1	Normal value	+1	+2	+3	+4
Temperature（θ/℃）	>40.9	39.0-40.9	-	38.5-38.9	36.0-38.4	34.0-35.9	32.0-33.9	30.0-31.9	<30.0
Heart rate(min^-1)	>179	140-179	110-139	-	70-109	-	55-69	40-54	<40
Respiratory rate(min^-1)	>49	35-49	-	25-34	12-24	10-11	6-9	-	<6.0
Serum sodium[c_B/(mmol?L^-1)]	>179	160-179	155-159	150-154	130-149	-	120-129	111-119	<111
Serum potassium[c_B/(mmol?L^-1)]	>6.9	6.0-6.9	-	5.5-5.9	3.5-5.4	3.0-3.4	2.5-2.9	-	<2.5
Serum creatinine（mg ? dL^-1）	>3.4	2.0-3.4	1.5-1.9	-	0.6-1.4	-	<0.6	-	-
Hematocrit(η/%)	>59.9	-	50.0-59.9	46.0-49.9	30.0-45.9	-	20.0-29.9	-	<20.0
Leukocytes（×10⁹ L^-1）	>39.9	-	20.0-39.9	15.0-19.9	3.0-14.9	-	1.0-2.9	-	<1.0
Serum bicarbonate[c_B/(mmol?L^-1)]	>51.9	41.0-51.9	-	32.0-40.9	22.0-31.9	-	18.0-21.9	15.0-17.9	<15.0

Clinical diagnosis and comprehensive treatment of Fournier’s gangrene: A case report and literature review

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