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New Indian Journal of Surgery

Volume  6, Issue 4, October-December 2015, Pages 145-147
 

Original Article

The Role of Fournier’s Gangrene Severity Index as a Predictor of outcome and a Tool for Optimum Management of Patients with Fournier’s Gangrene : A Prospective Clinical Study at a Tertiary Care Center

Rohan Khandelwal

Consultant - Onco-plastic Breast Surgeon, W Pratiksha Hospital, Golf Course Extension Road, Sushant Lok Phase 2, Sector 56, Haryana 122002.

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DOI: DOI : https://dx.doi.org/10.21088/nijs.0976.4747.6415.7

Abstract

 Background: Fournier’s gangrene is a potentiallyfatal acute, necrotizing fascitis of the scrotum andperineal region associated with a synergistic bacterialinfection of the subcutaneous fat and superficialfascia with a mortality rates ranging from 20-30%.Aims and objectives: The study was carried out withthe objective to assess the role of Fournier’s gangreneseverity index (FGSI) as a predictor of outcome inpatients with Fournier’s gangrene. Materials andMethods: A prospective study was carried out on 54consecutive male Fournier’s gangrene cases. The datawas collected in the Department of Surgery,Vardhman Mahavir Medical College, SafdarjangHospital. All patients were treated with broadspectrum antibiotics and serial surgical debridements.Results: Age of the patients varied from 27 yrs to 62yrs with the mean duration of stay being 19.6 days.Mortality rate observed in our study was 17(31.5%)out of the 54. 38.9%(21) of the cases were diabetic and51.9%(28) were alcoholics. 22(40.7%) cases had nosignificant history before the development of thedisease, whereas 32(59.3%) had some predisposingcondition prior to onset of gangrene. Majority of our patients 24(44.4%) had a polymicrobial infection with Pseudomonas aeruginosa 11(20.4%) being the next most common organism. The Fournier’s gangrene severity index score in the survivors (n=37) varied from a score of 1 to 7 compared to the non survivors in whom it was more than 7. All 17 cases who succumbed to the disease had an average Fournier’s gangrene severity index score of 9.4 (Range: 8-18) at the time of admission. The average FGSI score in the survivors was 3.8 (Range 0-7). Conclusions: Fournier’s gangrene still persists in our country and is a lethal condition, if not treated early and energetically. Diabetics are more susceptible to developing the disease and more often than not there is a definite predisposing factor before the onset of disease. Most of the cases have poly-microbial infection and some secondarily get infected by hospital acquired organisms. Fournier’s gangrene severity index is a simplified way of comparing patients with the disease and also has significance in predicting outcome and guiding management.


Corresponding Author : Rohan Khandelwal