Ulus Travma Acil Cerrahi Derg. 2012; 18(1): 43-48 | DOI: 10.5505/tjtes.2012.36599

Fournier gangreninde debridman sayýsýný etkileyen faktörler: 36 olguda sonuçlarýmýz

Cemal Göktaþ¹, Mehmet Yýldýrým², Rahim Horuz¹, Gökhan Faydacý¹, Oktay Akça¹, Cihangir Ali Çetinel^1
1Dr.Lütfi Kýrdar Kartal Eðitim Ve Araþtýrma Hastanesi, Üroloji Kliniði, Ýstanbul
²Dr.Lütfi Kýrdar Kartal Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul

AMAÇ
Bu çalýþmada, tek veya çok sayýda cerrahi debridman gereken Fournier gangreni (FG) hastalarý karþýlaþtýrýldý, debridman sayýsýný etkileyebilecek faktörler araþtýrýldý.
GEREÇ VE YÖNTEM
Fournier gangreni nedeniyle tedavi edilen 36 hastanýn verileri geriye dönük olarak incelendi. Hastalar uygulanan debridman sayýsýna göre iki gruba ayrýldý (Grup I: tek seans; Grup II: ≥2 seans). Hastalara ait veriler (klinik ve cerrahi veriler, lezyon özellikleri, FG þiddet indeksi, prognoz verileri) gruplar arasýnda karþýlaþtýrýldý.
BULGULAR
Hastalarýn ortalama yaþý 55,5 idi ve hepsi erkekti. Grup I’de 21, Grup II’de 15 hasta incelendi. Grup II’de ortalama debridman sayýsý 2,2 idi. Genel mortalite oraný %11 olarak saptandý (Grup I’de %4,8, Grup II’de %20; p=0,287). Diyabet en sýk karþýlaþýlan komorbidite idi (%44). Hastaneye baþvuruya kadar geçen süre, baþvuru sýrasýnda lezyonun boyutu ve FG þiddet indeksi açýsýndan gruplar arasýnda fark tespit edilmedi. Grup II’de FG þiddet indeksi skorunun tekrarlanan her operasyon öncesinde anlamlý derecede artýþ gösterdiði saptandý (p<0,05).
SONUÇ
Her ne kadar tek veya çok sayýda debridman uygulanan hastalar arasýnda debridman sayýsýný etkileyebilecek anlamlý fark saptanmamýþsa da; FG þiddet indeksi, tekrarlanan her debridmanda arttýðý tespit edildiði için, ilave debridmanlara karar vermede yardýmcý olabilir.

Anahtar Kelimeler: Debridman, Fournier gangreni; mortalite; prognoz; cerrahi prosedürler.

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Factors affecting the number of debridements in Fournier’s gangrene: our results in 36 cases

Cemal Göktaþ¹, Mehmet Yýldýrým², Rahim Horuz¹, Gökhan Faydacý¹, Oktay Akça¹, Cihangir Ali Çetinel^1
1Kartal Training And Research Hospital, Urology Department, Istanbul
²Kartal Training And Research Hospital, Surgery Department, Istanbul

BACKGROUND
We aimed to evaluate the factors potentially affecting the number of surgical debridements in patients with Fournier’s gangrene (FG) who underwent single or multiple operative sessions.
METHODS
We retrospectively reviewed the data of 36 patients with FG. The patients were assigned to one of two groups according to the number of debridements (Group I: single session; Group II: ≥2 sessions). Data of the patients (clinical and surgical data, lesion characteristics, FG severity index, and prognosis) were compared between the groups.
RESULTS
The mean age of the patients was 55.5 years, and all were male. Group I consisted of 21 patients and Group II of 15 patients. The mean number of debridements was 2.2 in Group II. Our overall mortality rate was 11% (Group I: 4.8% vs Group II: 20%; p=0.287). Diabetes was the most common coexistent pathology (44%). Time to admission to the clinic, size of the lesions at admission, and FG Severity Index (FGSI) scores of the groups were similar. In Group II, FGSI scores were found increased before each of the repeated debridement sessions (p<0.05).
CONCLUSION
There was no difference in the clinical data of the patients who required single or multiple debridement sessions; however, FGSI may be useful in deciding repeated debridements, as it was found increased at each repeated session.

Keywords: Debridement, Fourniers gangrene; mortality; prognosis; surgical procedures.

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