Uludağ Fournier Gangreni Şiddet İndeksi’nin Fournier Gangreni’nde Prognozu Değerlendirmedeki Katkısı

Öz

Fournier gangreni (FG), perineal, perianal ve ürogenital deri ve deri altı dokuların gangrenöz süpüratif bir hastalığıdır. Bu çalışmada kliniğimizde FG nedeniyle opere ettiğimiz hastalarımızda, Uludağ Fournier Gangreni Şiddet İndeksi (UFGSI)’ni kullanarak morbidite ve mortalitenin öngörülebilirliğini değerlendirmeyi amaçladık. Çalışmaya Ocak 2012 ile Aralık 2022 tarihleri arasında kliniğimizde FG nedeniyle ameliyat edilen ve çalışma kriterlerini karşılayan 35 hasta dahil edildi. Veriler retrospektif olarak hasta dosyaları incelenerek toplandı. 35 hastanın 10 tanesinde UFGSI skoru 9 ve üzerinde idi ve bu hastaların üçünde hastalık mortal seyretti. Skoru 9’un altında olan 25 hastadan sadece birinde mortalite görüldü. Tüm agresif tedavi seçeneklerine rağmen FG’nin mortalite oranı yüksektir. UFGSI skorlama sistemi mortalitenin güvenilir bir öngörücüsü gibi görülmektedir.

Anahtar Kelimeler

• fournier gangreni
• fournier gangreninde mortalite
• UFGSI skoru

Contribution of Uludağ Fournier Gangrene Severity Index to Evaluating Prognosis in Fournier Gangrene

Öz

Fournier’s gangrene (FG) is a gangrenous, suppurative disease of the perineal, perianal, and urogenital skin and subcutaneous tissues. This study aimed to assess our patients who underwent FG surgery in our clinic using the Uludağ Fournier Gangrene Severity Index (UFGSI) to predict mortality and morbidity. The study included 35 patients who underwent surgery for FG in our clinic between January 2012 and December 2022 and met the study criteria. Data were collected retrospectively by reviewing patient files. The severity score was more than 9 in 10 of the 35 patients, and the disease was fatal in three of them. Only one of the 25 patients with scores below the threshold died. Despite all aggressive treatment options, FG has a high mortality rate. The UFGSI scoring system appears to be a reliable predictor of mortality.

Anahtar Kelimeler

• Fournier’s Gangrene
• Mortality in Fournier’s Gangrene
• UFGSI Score

Kaynakça

1. 1. Baurienne H. Sur une plaie contuse qui s’ est terminee par le sphacele de le scrotum. J Med Chir Pharm. 1764;20:251-6.
2. 2. Prohorov AV. Furnier’s gangrene. Kazan Med J 2016;97:256-61.
3. 3. Montrief T, Long B, Koyfman A, Auerbach J. Fournier Gangrene: A Review for Emergency Clinicians. J Emerg Med. 2019 Oct;57(4):488-500.
4. 4.Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, et al.Fournier’s Gangrene: literature review and clinical cases. Urol Int 2018;101:91-97.
5. 5.Mallikarjuna MN, Vijayakumar A, Patil VS et al. Fournier’sgangrene: Current Practices. ISRN Surg 2012: 937–42.
6. 6.Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier's gangrene. The Journal of urology 1995; 154: 89-92.
7. 7.Pessa ME, Howard RJ (1985) Necrotizing Fasciitis. Surg Gynecol Obstet 161:357–361.
8. 8.Ersay A, Yilmaz G, Akgün Y et al. Factors affecting mortality of Fournier’s gangrene: review of 70 patients. ANZ J Surg2007; 77:43–48.

9. 9.Dahm P, Roland FH, Vaslef SN et al. Outcome analysis inpatients with primary necrotizing soft tissue infections of the male genitalia. Urology 2000; 56:31–36.
10. 10.Tuncel A, Aydin O, Tekdogan U et al. Fournier’s gangrene: three years of experience with 20 patients and validity of theFournier’s gangrene severity index score. Eur Urol 2006; 50:838–843.
11. 11.Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg2000; 87:718–728.
12. 12.Yilmazlar T, Ozturk E, Alsoy A, Ozguc H. Necrotizing soft tissue infections: APACHE II score, dissemination, and survival. World J Surg 2007; 31:1858–1862.
13. 13.Yilmazlar T, Ozturk E, Ozguc H, Ercan I, Vuruskan H, Oktay B.Fournier’s gangrene: an analysis of 80 patients and a novelscoring system. Tech Coloproctol. 2010;14:217-23.
14. 14.Sarkis P, Farran F, Khoury R, et al. Gangrène de Fournier : revue de la littérature récente[Fournier’s gangrene: a review ofthe recent literature]. Prog Urol. 2009;19(2):75–84.
15. 15.Sarkut P, Işık Ö, Öztürk E, Gülcü B, Ercan İ, Yılmazlar T.Gender does not affect the prognosis of Fournier's gangrene:acase-matched study. Ulus Travma Acil Cerrahi Derg.2016;22:541–4.
16. 16.Fernando SM, Tran A, Cheng W, et al. Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging, and LRINEC score: a systematic review and meta-analysis. Ann Surg. 2019;269(1):58–65. 73.
17. 17.Zacharias N, Velmahos GC, Salama A, et al. Diagnosis of necrotizing soft tissue infections by computed tomography. Arch Surg. 2010;145(5):452–455. 74.
18. 18.Ballard DH, Mazaheri P, Raptis CA, et al. Fournier Gangrenein men and women: appearance on CT, Ultrasound, and MRI and what the surgeon wants to know. Can Assoc Radiol J. 2020;71(1):30–39.
19. 19.Yoneda A, Fujita F, Tokai H, et al. MRI can determine the adequate area for debridement in the case of Fournier’s gangrene. Int Surg. 2010;95(1):76–79.
20. 20.Avery LL, Scheinfeld MH. Imaging of penile and scrotal emergencies. Radiographics. 2013;33(3):721–740.
21. 21.Barupal SR, Soni ML, Barupal R. Factors Affecting Mortality Following Necrotizing Soft-Tissue Infections: RandomizedProspective Study. J Emerg Trauma Shock. 2019;12:108-16.
22. 22.Yılmazlar T, Işık Ö, Öztürk E, Özer A, Gülcü B, Ercan İ.Fournier’s gangrene: review of 120 patients and predictors of mortality. Ulus Travma Acil Cerrahi Derg. 2014;20(5):333-7.
23. 23.Zhang KF, Shi CX, Chen SY, Wei W. Progress inmultidisciplinary treatment of Fournier's gangrene. Infect DrugResist. 2022;15:6869–6880.
24. 24.Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486–552.
25. 25.Nawijn F, Smeeing DPJ, Houwert RM, et al. Time is of theessence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg. 2020;15:4.
26. 26.Chawla SN, Gallop C, Mydlo JH. Fournier’s Gangrene: ananalysis of repeated surgical debridement. Eur Urol. 2003;43(5):572–575.
27. 27.Pastore AL, Palleschi G, Ripoli A, et al. A multistep approach to manage Fournier’s gangrene in a patient with unknown typeII diabetes: surgery, hyperbaric oxygen, and vacuum-assisted closure therapy: a case report. J Med Case Rep 2013; 3; 7.
28. 28.Karian LS, Chung SY, Lee ES. Reconstruction of defects after Fournier gangrene: a systematic review. Eplasty. 2015;15:e18.
29. 29.Eğin S., Kamalı S., Hot S., Gökçek B., Yeşiltaş M., Duman M.G., Alemdar A. The importance of the scoring system inFournier’s gangrene. Ulus. Travma Acil Cerrahi Derg. 2023;29:109–115.