Treatment ultimately requires surgical debridement of the necrotic tissue. Broad-spectrum antibiotics, however, should be commenced immediately upon suspicion of Fournier's gangrene. Most sources advise a combination of cephalosporins or aminoglycosides, penicillins, and metro nidazole or clindamycin (Thomsen & Legome, 2005; Yala marthi & Dayal, 2006). Genta mycin may be used in lieu of cephalosporins for gram-negative coverage (Moses, 2005). For patients allergic to penicillin, vancomycin and gentamycin are recommended. Rarely a fungus may be implicated as a source of the underlying infection, in which case antifungal therapy would be indicated (Moses, 2005; Rutchik & Sanders, 2003). Along with antibiotic therapy, tetanus prophylaxis is recommended.
Aggressive surgical excision of all necrotic tissue is required and should be performed as soon as possible. On average, two to four operative procedures are necessary to sufficiently remove all affected fascia (Thomsen & Legome, 2005). Maggots have been implemented experimentally, with optimistic results, to eradicate traces of marginal necrotic tissue in high-risk surgical patients to prevent multiple OR visits (Angel, Grassberger, Huemer, & Stackl, 2000). Other experimental treatments include hyperbaric oxygen and honey wound dressings. Hyperbaric oxygen therapy promotes wound healing by reversing hypoxic conditions and enhancing leukocyte and macrophage activity. It also potentiates the transport of antibiotics across the bacterial cell wall (Wright, 2001; Yalamarthi & Dayal, 2005). Widely used in India, honey inhibits bacterial and fungal growth due to its low pH, high viscosity, and increased level of antioxidants. Preliminary trials comparing honey dressings with conventional open wound dressings by observing rate of granulation tissue formation, occurrence of secondary infection, and length of hospital stay in patients with Fournier's gangrene have rendered promising results (He jase, Simonin, Bihrile, & Coogan, 1996; Molan, 2001; Ugane, 2004).
Urol Nurs. 2007;27(4):296-299. © 2007 Society of Urologic Nurses and Associates
Cite this: A Case of Fournier's Gangrene - Medscape - Aug 01, 2007.