Síndrome de Fournier: estudo de 32 pacientes do diagnóstico à reconstrução / Fourniers gangrene: study of 32 patients from diagnosis to reconstruction
GED gastroenterol. endosc. dig
; 33(2): 45-51, abr.-jun. 2014. ilus
Article
in Portuguese
| LILACS
| ID: lil-763851
Responsible library:
BR9.1
RESUMO
Objetivo:
apresentar a experiência do serviço, enfatizando a importância do diagnóstico precoce, tratamento cirúrgico agressivo, ampla cobertura antibiótica e a necessidade de reconstrução do períneo destes pacientes. Material eMétodos:
estudo de 32 pacientes consecutivos tratados de novembro de 1998 a janeiro de 2008.Resultados:
31 (96,8%) masculinos e um (3,2%) feminino. Quanto à etnia, 20 eram brancos, sete pardos e cinco negros. A idade variou entre 23 e 88 anos (média de 50,9 anos). A lesão inicial foi identificada em todos os casos, sendo o abscesso (genital/perianal) responsável por 27 (84,3%) dos pacientes. Os fatores associados estiveram presentes em 18 (56,3%) casos diabetes mellitus em 10, alcoolismo em sete, paraplegia em seis, AIDS em três, obesidade em três e desnutrição em dois; destes cinco (15,6%) eram presidiários. O tratamento consistiu de desbridamento cirúrgico precoce e agressivo, com média de 1,5 por paciente. Realizaram-se quatro (12,5%) colostomias em alça e sete (21,8%) cistostomias. A associação de ceftriaxona com clindamicina foi utilizada em 15 (46,8%) pacientes. A reconstrução foi feita por sutura primária ? nove casos (28,1%); retalhos cutâneos locais e cicatrização por segunda intenção ? sete casos (21,8%)/cada; enxertos de pele parcial ? seis casos(18,7%). Três pacientes morreram (9,3%). O tempo médio de permanência hospitalar foi de 26,1 dias.Conclusão:
O diagnóstico precoce aliado ao desbridamento cirúrgico extenso são medidas importantes na contenção da rápida progressão da síndrome, associados a medidas de suporte clínico e ampla cobertura antimicrobiana. Os métodos de reconstrução têm um papel importante no sentido de minimizar as deformidades, restituindo ao paciente sua autoimagem.ABSTRACT
Objective:
to evaluate the experience of our institution, emphasizing the importance of early diagnosis, aggressive surgical débridement combined with broad-spectrum antibiotic, and the need for reconstruction of the perineum these patients.Methods:
study of 32 consecutive patients treated from November 1998 to January 2008.Results:
there were 31 (96.8%) males and one (3.2%) female. The patients ranged in age from 23 to 88 years (mean age 50.9 years). Of the 31 patients, 20 (62.5%) were white, seven (21.8%) were non-white and five (15.5%) were black. The primary lesion was localized in all cases, being the abscess (genital/perianal) responsible for 27 (84.3%) patients. There were a number of predisposing factors in eighteen patients (56.3%). Ten patients were diabetic, 7 were alcoholic, 6 were paraplegic, 3 had AIDS, 3 (9.3%) were obese. There was malnutrition in 2 (6.4%) and 5 (15.6%) were penitentiary inmates. The treatment consisted of precocious and wide surgical debridement which was performed in all patients. Most patients received multiple debridements (mean 1.5 per patient). There were 4 (12.5%) colostomies and 7 (21.8%) cistostomies. Fifteen patients (46.8%) received broad-spectrum antibiotic coverage (ceftriaxone associated with clindamicyn). Nine patients (28.1%) had primary suture, seven patients (21.8%) had local cutaneous grafts and second intention healing; three patients (9.3%) died. The average hospital stay was 26.1 days.Conclusion:
FG requires a prompt diagnosis, immediate surgical treatment and antibiotic coverage. Methods of reconstruction are important not only for minimizing deformities but also for restoration of the patient autoimage.
Full text:
Available
Collection:
International databases
Database:
LILACS
Main subject:
Fournier Gangrene
Type of study:
Diagnostic study
/
Prognostic study
/
Screening study
Limits:
Adult
/
Aged
/
Aged, 80 and over
/
Female
/
Humans
/
Male
Language:
Portuguese
Journal:
GED gastroenterol. endosc. dig
Journal subject:
Gastroenterology
Year:
2014
Document type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Colégio Brasileiro de Cirurgiões/BR
/
Hospital Mandaqui/BR
/
Instituto Tocantinense Presidente Antônio Carlos/BR