A. Vitin 's Gangrene - Current Concepts and Management Options PDF

By A. Vitin

ISBN-10: 9533073861

ISBN-13: 9789533073866

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Extra info for Gangrene - Current Concepts and Management Options

Example text

Our aim was to describe the clinical and therapeutic features and to analyze the prognostic factors that may influence the postoperative course. 2. Methods Our retrospective study analysed 35 consecutive cases of perineal gangrene treated in the “A” surgical department of Charles Nicolle hospital (Tunisia) between 1997 and 2004. All the cases of perineal gangrene were included whatever the gateway: proctologic, urogenital, post-traumatic or postoperative. Gangrene that did not reach the perineum and perianal suppuration without cellulitis nor myonecrosis mentioned on the operative report were excluded.

Genera of Enterobacteriaceae family, anaerobic organisms and fungi. Most authorities believe the polymicrobial nature of Fournier gangrene is necessary to create the synergy of enzyme production that promotes rapid multiplication and spread of the infection 11. For example, one microorganism might produce the enzymes necessary to cause coagulation of the nutrient vessels. Thrombosis of these nutrient vessels reduces local blood supply. Thus, tissue oxygen tension falls. The resultant tissue hypoxia allows growth of facultative anaerobes and microaerophilic organisms.

Poor perineal hygiene or the presence of chronically indwelling catheters, such as in paraplegic patients, poses an increased risk. Wound cultures from patients with Fournier gangrene reveal that it is a polymicrobial infection with an average of four isolates per case. Escherichia coli is the predominant aerobe, and Bacteroides species the predominant anaerobe. Other common microflora includes Proteus, Staphylococcus, Enterococcus, aerobic and anaerobic Streptococcus, Pseudomonas, Klebsiella, and Clostridium.

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Gangrene - Current Concepts and Management Options by A. Vitin


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