The perineo scrotal gangrene : concerning 60 cases

The perineo-scrotal gangrene is a necrotizing fasciitis concerningthe soft parts of the genital area which necessitates a rapid, completeand multidisciplinary care.Patients and methods : Sixty patients with gangrene of the externalgenitalia were treated in our centre from January 1985 to March2002. We analysed the evolution in relation with various therapeuticmethods. The established treatment is based on a tripod withunequal efficacy: reanimation with antibiotherapy, hyperbaric oxygentherapy and surgery (excision, drainage …).Mean age of patients was 42 years (20-65 years). Fifteen patientswere diabetic, two had corticosteroid treatment, one was a dialysispatient and another one was cirrhotic.Results : An anorectal cause was found in 20 patients and an urogenitalpathology in 24. In 3 patients, gangrene occurred in the postoperativecourse. In 13 cases the necrotizing fasciitis could not berelated to any cause. All patients were treated with triple antibioth erapyand radical excision of necrotic tissues. Twenty patients hadhyperbaric oxygen therapy.There were 12 deaths (20%). Results were encouraging, with 42patients cured without sequelae and 6 after plastic reconstruction.Conclusion : The perineoscrotal gangrene remains, in spite of amultidisciplinary care, a serious affection burdened with high mortalitythat the correction of general disorders and of immune deficienciescan improve.