Hyperbaric oxygen in the treatment of Fournier's gangrene

Objective: To investigate the efficacy of operation, antibiotic treatment, hyperbaric oxygen, and surgical intensive care in the management of Fournier's gangrene. Design: Retrospective study. Setting: University hospital, Finland. Subjects: 33 patients, most of them referred from other hospitals. Intervention: Debridement, broad spectrum antibiotics, and hyperbaric oxygen (HBO) treatment at 2.5 atmospheres absolute pressure. Excision of necrotic tissue and incisions in the affected areas. Urinary and faecal diversions when necessary. Main outcome measures: Morbidity and mortality. Results: Only three patients died (9%). Hyperbaric oxygen reduced systemic toxicity, prevented extension of the necrotising infection, and increased demarcation, thereby improving the overall outcome. Conclusion: To reduce mortality and morbidity, effective treatment of Fournier's gangrene should be started promptly. Debridement and antibiotics combined with surgical intensive care must be started as soon as possible. Hyperbaric oxygen is both life and tissue saving. It is an important adjunct that prevents extension of necrosis and reduces systemic toxicity.