الفهرس 
Introduction and aim of the work
History and backgroundOnly 14 pages are availabe for public view
 |  | from | 117 |  |  |
| | | from | 117 | | |
Abstract
Fournier’s gangrene is a polymicrobial necrotizing fascitis involving the genital, perianal or perineal regions. The infective process leads to thrombosis of subcutaneous blood vessels, resulting in gangrene of the overlying skin. In spite of the fact that more than 120 years had passed since the original description of Fournier’s gangrene, the disease still constitutes a real challenge for the contemporary surgical practice. The multifactorial etiology and predisposition, the unpredictable and confusing course and the catastrophic and fatal outcome illustrate the ugly portrait of the disease. Our work aimed to study the clinical, microbiological and immunological aspects of Fournier’s gangrene. The study included 22 patients who were investigated for wound culture, immunological assay of IL2, ICAM1, T cell function and gamma interferon. The results obtained were compared against healthy controls . The mean age of cases was (51.7 (R+ (B13.3) ranging from (370 years) 2 females and 20 males. 14 patients (63.6%) were diabetic (P<0.0001). Extent of the disease varied among the affected cases; it was confined to the scrotum in 8 cases (36%), confined to perineum in 4 cases (17%), confined to penis 1 case (4.5%), involving scrotum and perineum in 5 cases (23%), buttock in 2 cases (9%), anterior abdominal wall in 1 case (4.5%), thigh in 1 case (4.5%). The primary source of infection was identified in 82% of cases with colorectal sources (36.4%), genitourinary (27.3%), dermatological (18.2%). All cases showed polymicrobial culture results with E. coli and Gram +ve streptococci being the most frequently isolated organisms (45.5% for each). Among the cases investigated 4 cases died (18.2%) from speticemia, renal failure and hepatic cell failure. The immunological status of the patients was assessed using T cell function, IL2, ICAM1 and gamma interferon. They were significantly different from the healthy controls (P<0.05, P<0.0001, P<0.001, P<0.001) respectively, while there was nonsignificant difference in these parameters when comparing survivals and nonsurvivals apart from IL2 which was significantly lower in the nonsurvivals (P<0.005) . All cases had urgent wound debridement in first 24 hours with 45.5% of the cases underwent multiple debridements.