FG, first described as a rapidly progressing idiopathic infection, includes any necrotising infection of the external genitals and perineum in both men and women.[7
] It is usually a polymicrobial infection whose probable physiopathology is due to endarteritis obliterans of the small and superficial veins, resulting in gangrene.[2
] Despite aggressive wide-spectrum antibiotic treatment, aggressive surgical debridement, intensive care and anaesthesia, the mortality rates are as high as 43% in some series.[3
Anaerobic and aerobic organisms that have been isolated from the most common wounds are: E. coli, Bacteroides
spp. and Staphylococcus
] In the present series, E. coli
was the predominant bacterium. There is no consensus on clinical variables for predicting FG results. Lower limb and abdominal wall involvement are associated with high mortality rate. Studies have shown that aggressive therapy, age, comorbidities and time of presentation do not affect prognosis.
Many prognostic factors such as advanced age,[1
] primary anorectal infections,[1
] delayed treatment, synergistic sepsis on admission,[8
] and high FGSI score[4
] have been reported in literature for FG. Other predisposing factors include local trauma, paraphimosis, periurethral extravasation of the urine, perirectal or anal infections, and surgeries such as circumcision or herniorrhaphy.[15
In our study, we found that higher mortality was seen with increasing age in patients more than 50 years of age.[1
] Overall mortality was 26.6%. This was consistent with other series.[12
] In this study, it was observed that if the time interval between the first symptom and surgical intervention is increased, the mortality is increased, which is consistent with other studies.[14
Although the majority of the patients presented in this series had DM (54.5%), other predisposing factors including previous surgeries (9.2%), trauma (4.6%) and alcoholism (16.9%) were also present. There is still controversy as to whether the coexistence of DM influences prognosis.[18
] But in our study, which is consistent with the report of Korkut et al
., DM was significant in the mortality group.
We found the presence of sepsis on admission also to be a prognostic factor for FG and its mortality, as reported by Unalp et al
Treatment for FG must be started as early as possible. Early and aggressive debridement and use of wide-spectrum antibiotics are the gold standard for decreasing the mortality and morbidity.[19
Debridement must be repeated with the same aggressive approach when necessary.[19
] We preformed repeated debridements in 65.2% of the FG patients in our study.
Some published series have emphasised that hyperbaric oxygen therapy can be helpful for the management of FG. Limitations in the availability and transfer of the patients to units offering this service restrict its application for the patients with FG.[20
] Consequently, we did not utilise hyperbaric oxygen therapy for our patients.
FGSI, which was developed by Loar et al
., is a good prognostic tool for assessing the FG patients.[4
] Mean FGSI in our study was 5.8, 4.6 and 11.1 in all patients, in surviving patients and in patients who died, respectively. We also find that FGSI score system is a good tool for predicting severity of the disease and mortality risk of the patients.[19
FG is an infectious process that can lead to death in up to 40% of patients. Early diagnosis and aggressive surgical interventions, and intensive postoperative care have undoubtedly controlled the mortality rates. Understanding the physiopathology and predisposing factors is essential for early diagnosis and treatment. There is currently no level I evidence for the use of indices for predicting mortality.
In our multicentre study, we have found that older age, DM, anaemia, sepsis, delay in initial treatment and FGSI core ≥9 are the important predicting severity factors.