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This article investigates the application values of Xenogenic (porcine) acellular dermal matrix (XADM) in preparation of a Fournier gangrene wound bed. Thirty-six consecutive cases of patients with Fournier gangrene between 2002 and 2012 were enrolled in our department of our hospital. The patients were divided into two groups according to different methods of wound bed preparation after surgical débridement, including the experimental group (17 cases) and the control group (19 cases). The wounds in the experimental group were covered with XADM after surgical wound débridement, whereas the wounds were cleaned with hydrogen peroxide and sodium hypochlorite solution (one time/day) in the control group. The wound bed preparation time and hospital stay were then compared in the two groups. The wound preparation time was 13.64 ± 1.46 days and hospitalization period was 26.06 ± 0.83 days in the experimental XADM group. In the control group, the wound bed preparation time and hospitalization period were 22.37 ± 1.38 and 38.11 ± 5.60 days, respectively. The results showed statistical differences between these two groups. When used in wound débridement after Fournier gangrene, XADM protects interecological organizations, promotes the growth of granulation tissues, and maximally retains function and morphology of the perineum and penis.

IntroductionFournier’s gangrene (FG) is a necrotizing fasciitis affecting the perineum and urogenital tissue. The mortality rate is high although early detection and aggressive debridement can reduce mortality by up to 16%. The prevalence of sequelae is very high and a colostomy is often necessary to control the perineal wound.Material and methodsA retrospective study was carried out to recruit all patients operated on by the General Surgery and Urology Departments with a diagnosis of GF at the University Hospital over 22 years. Mortality, the Fournier gangrene severity index (FGSI), and fecal diversion (either surgical (colostomy) or straight (Flexi-seal)) are collected.ResultsA total of 149 patients met the inclusion criteria. FG’s most frequent cause was a perianal abscess (107 patients—72%). Eighteen patients (12%) died of a specific cause of FG. Age (p = 0.014) and patients with an oncological history (p = 0.038) both were the only mortality risk factors for mortality according to logistic regression. Fifty patients required some form of fecal diversion in the postoperative period (32 colostomies and 18 Flexi-seal). Neither the use of postoperative fecal diversion (surgical or Flexi-seal) nor the timing of its use had any effect on postoperative mortality.ConclusionsOne in eight patients died in the immediate postoperative period secondary to FG. Despite improved outcomes, 22% required a colostomy during admission. However, neither the performance of a colostomy nor the timing was associated with decreased FG-associated mortality. Non-invasive methods should be used first and surgical bowel diversion should be postponed as long as possible.

PurposeTo compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG).MethodsA comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia’s largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems.ResultsTen scoring systems were found, i.e., Fournier’s Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860–0.950), SOFA (AUROC 0.830, 95% CI 0.815–0.921), and NFS (AUROC 0.823, 95% CI 0.739–0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91.ConclusionThis study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.

Purpose The aim of our study was to demonstrate the role of The Controlling Nutritional Status (CONUT) score in predicting mortality after Fournier’s Gangrene (FG) debridement by comparing it with other scoring systems. Methods Data of 193 patients who underwent debridement for FG between January 2013 and December 2024 were retrospectively analyzed. Survivor 156 patients (Group S) and 37 non-survivor patients (Group NS) were divided into two groups. Four scoring systems commonly used to predict mortality in FG and the CONUT score were compared by regression analyses. Cut-off values were determined for each scoring system and ROC curves were constructed. Results Mortality rate was 19.2%. Total CONUT and other scoring systems were higher in Group NS ( p  < 0.001). In multivariate analyses, an increase in Total CONUT score predicted mortality (OR = 99.26; 95% CI 8.19–120.30: p  < 0.001). The sensitivity, specificity, PPV, NPV and AUC values at the CONUT score ≥ 2.5 cut-off were 86%, 87%, 87%, 87%, 96% and 0.935 (95% CI: 0.88–0.98; p  < 0.001), respectively. Conclusion The CONUT score predicts mortality in FG with high sensitivity and specificity. It is also easy and practical to calculate.

PurposeTo explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier’s gangrene wound therapy.Patients and MethodsThis is a retrospective multi-institutional cohort study. Data of 92 patients from nine centers between 2007 and 2018 were retrospectively analyzed. After surgery, patient having a local or a disseminated FG were managed with VAC therapy or with conventional dressings. The 10-weeks wound closure cumulative rate and OS were analyzed.ResultsOf the 92 patients, 62 (67.4%) showed local and 30 (32.6%) a disseminated FG. After surgery, 19 patients (20.7%) with local and 14 (15.2%) with disseminated FG underwent to VAC therapy; 43 (46.7%) with local and 16 (17.4%) with disseminated FG were treated using conventional dressings. The multivariable logistic regression analysis demonstrated that the VAC in patients with disseminated FG led to a higher cumulative rate of wound closure than patients treated with no-VAC (OR = 6.5; 95% CI 1.1–37.4, p = 0.036). The Kaplan–Meier survival curves for the OS showed a significant difference between no-VAC patients with local and disseminated FG (OS rate at 90 days 0.90, 95% CI 0.71–0.97 vs 0.55, 95% CI 0.24–0.78, respectively; p = 0.039). Cox regression confirmed that no-VAC patients with disseminated FG showed the lowest OS (hazard ratio adjusted for sex and age HR = 3.4, 95% CI 1.1–10.4; p = 0.033).ConclusionsIn this large cohort study, VAC therapy in patients with disseminated FG may offer an advantage in terms of 10-weeks wound closure cumulative rate and OS at 90 days after initial surgery.

Background Fournier’s Gangrene is a severe surgical infectious disease, and various risk factors can increase its mortality rate. The purpose of this study is to retrospectively analyze the clinical characteristics and laboratory data of Fournier’s Gangrene patients, followed by an analysis of mortality-related risk factors. This study has no secondary objectives. Methods This study included 46 hospitalized patients diagnosed with Fournier’s Gangrene at Suzhou Traditional Chinese Medicine Hospital from December 2013 to March 2024. Clinical data for all patients were extracted from the electronic medical records system. The collected data included gender, age, duration of illness, length of hospital stay, sites of infection involvement, comorbidities, white blood cell count, hematocrit, albumin, blood glucose, creatinine, serum sodium, serum potassium upon admission, microbial culture results, and patient outcomes (survival/death). The Simplified Fournier Gangrene Severe Index (SFGSI) was used to score all patients. Patients were categorized into survival and death groups based on clinical outcomes. Differences between categorical variables were compared using the χ² test or Fisher’s exact test. Differences between numerical variables were compared using Student’s t-test or the Mann-Whitney U test. Binary logistic regression was employed to analyze the risk factors for mortality in Fournier’s Gangrene. Results Among the 46 Fournier’s Gangrene patients, 39 were male (84.8%) and 7 were female (15.2%). The age ranged from 17 to 86 years, with a median age of 61 years. Fourteen cases (30.4%) were confined to the perianal area, 26 cases (56.5%) had fascial necrosis involving the perianal, perineal, and genital regions, while 6 cases (13.0%) extended to the abdominal wall. At a 3-month postoperative follow-up, 43 patients (93.5%) survived, while 3 patients (6.5%) died shortly after admission due to severe illness. Based on the outcome, patients were divided into survival and death groups with 43 and 3 cases, respectively. Significant differences were observed between the two groups in terms of age ( P <0.05), extension to the abdominal wall ( P <0.01), hematocrit ( P <0.01), albumin ( P <0.01), SFGSI ( P <0.01), and SFGSI>2 ( P <0.01). Binary logistic regression analysis indicated that decreased hematocrit was an independent risk factor for mortality in Fournier’s Gangrene patients. Conclusion This study provides a detailed analysis of the clinical characteristics and risk factors for mortality in Fournier’s Gangrene patients. The primary outcome of this study is that a decreased hematocrit is an independent risk factor for predicting mortality in FG patients. These findings offer valuable prognostic insights for clinicians, underscoring the importance of early identification and correction of reduced hematocrit to improve patient outcomes and survival rates.

PurposeFournier’s gangrene (FG) is a rare potentially lethal necrotising infection of the perineum. While the gold standard management is early and aggressive surgical debridement, the evidence in the literature is unclear as to the role and outcomes of diversional stoma.MethodsA systematic review was conducted to identify studies investigating the relationship between stoma formation and FG. Meta-analyses were performed using a random-effects model.ResultsTwenty-seven studies (n=1482) were included. There was no significant difference in disease severity scores between the stoma and no stoma groups. Mortality rate was significantly higher in patients who required diversional stoma (OR 1.71, 95% CI 1.13–2.59, p=0.01). Significantly more surgical procedures were performed on patients who underwent stoma formation, and the total hospital cost was also higher in this group. This study may have been limited by bias in patients with more fulminant course or sphincter damage requiring stoma as a medical necessity.ConclusionThese findings suggest that the use of diversional stoma in FG is a predictor of poor outcomes. This study demonstrated that mortality rate remained high and a diversional stoma did not reduce risk of mortality as suggested by smaller case series. Its use should therefore be individualised based on disease severity and sphincter damage.

Background Deep-pelvic Fournier’s gangrene (FG) spreading via supralevator abscesses is a rare yet clinically challenging condition, often requiring meticulous surgical intervention to ensure adequate drainage while avoiding critical anatomical injury. Although combined suprapubic and transsacral approaches for extraperitoneal compartment access and linked-loop drainage systems represent innovative strategies, their efficacy and outcomes remain underreported. This study aimed to analyze the clinical outcomes of patients with deep-pelvic Fournier gangrene treated using this dual-approach technique. Methods This observational retrospective study included nine patients diagnosed with deep-pelvic FG complicated by extraperitoneal extension across three tertiary medical centers (January 2015–August 2024). Results Data from nine patients, including age, sex, body mass index, and comorbidities, were extracted and analyzed. All of the patients were successfully drained by the combined suprapubic and transsacral approach. No postoperative morbidity and secondary debridement occurred. During the follow-up period, 3 patients developed anal fistulas, which were subsequently treated with fistulectomy. Conclusion The combined suprapubic and transsacral approach demonstrated high procedural success and favorable healing outcomes in treating deep-pelvic FG.

Purpose of review This review explores new evidence in Fournier’s Gangrene management, emphasizing survivorship. We highlight the shift toward skin-sparing debridement techniques, new reconstructive strategies, and highlight limited evidence on outcomes. Additionally, we examine recent evidence on diagnosis, antimicrobial therapy, adjunctive treatments, and post-operative wound care. Recent findings New evidence supports the feasibility of skin-sparing debridement, reducing the need for extensive reconstruction while improving primary closure rates and lowering healthcare costs. Advances in reconstructive techniques accelerate wound healing and shorten hospital stays. Optimized wound management—integrating antimicrobial solutions, negative pressure therapy, and targeted antibiotics—continues to improve recovery while minimizing morbidity and mortality. Summary Modern Fournier’s management prioritizes early recognition, tissue preservation, and early genital reconstruction. Despite advancements, gaps remain in early diagnosis and long-term outcomes after the index admission. Further research on post-reconstruction recovery is essential to refine treatment protocols and determine quality of life for affected patients.

Congenital gangrene in newborns is a rare condition characterised by tissue gangrene present at birth. It may result from intrauterine vascular compromise, birth trauma or clotting disorders. Early diagnosis and prompt management, including surgical intervention and supportive care, are critical to prevent severe complications and improve survival outcomes. We are reporting a case of congenital gangrene of the gluteal region in the newborn.