13 Treatment Resuscitation Broad-spectrum antibiotics Penicillins, Metronidazole, 3rd generation cephalosporinsSurgical Debridementintroduced by Meleney in 1920sRepeated if necessaryLaucks SS II. Fournier’s gangrene. Surg Clin North Am 1994; 74:Meleney FL. Hemolytic streptococcus gangrene. Arch Surg 1924; 9:
15 Colostomy? 18 Colostomy Mortality: 14 during 1st debridement Dis Colon Rectum 2003; 46: 649–52.18 Colostomy14 during 1st debridement4 on D5, 7, 7, 8Mortality:Stoma: 7/18 (38.9%),No stoma: 2/27 (7.4%)P=0.009
16 Colostomy?57 cases (1985 – 1996)Fecal diversion is not a prognostic factorEarly colostomy may reduce mortality
17 Colostomy Indications: Timing? Anal sphincter involvement Colonic or rectal perforationDecrease wound contaminationFacilitate nursing careTiming?E. Villanueva Experience in management of Fournier’s gangrene Tech Coloproctol (2002)6:5-13
18 Colostomy? 18 Colostomy Mortality: 14 during 1st debridement Dis Colon Rectum 2003; 46: 649–52.18 Colostomy14 during 1st debridement4 on D5, 7, 7, 8Mortality:Stoma: 7/18 (38.9%),No stoma: 2/27 (7.4%)P=0.009
19 Colostomy – When? 8 cases 4 colostomies 1 in 1st debridement 3 in D3, 5, 5
20 Colostomy – When? 4 cases (1998-2003) Colostomy on 2nd look OT (D2,3,5,5)Improved POSSUM scoresMostly required 2nd debridement<10% of ICU patients had BO in first 48hrsPhysiological and operative severity score for the enumeration of mortality and morbidities
21 Colostomy – When? No consensus yet Trend: on subsequent debridement, when physiological condition improvedAlternatives?
22 Alternatives2 casesFlexi-Seal Fecal Management System
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