Fournier's gangrene: an analysis of repeated surgical debridement

OBJECTIVES: We wanted to determine if there was a difference in outcome for those patients with Fournier's disease who underwent numerous debridements as opposed to only one initial debridement. METHODS: The records of 19 patients with the diagnosis of Fournier's gangrene were reviewed retrospectively at our institution. Special attention was placed on demographic data, primary managing service, as well as wound cultures, and the number and timing of surgical debridements. Patients were also classified by a collection of variables at presentation and given a score named the Fournier's Severity Index. We utilised the Fournier's Severity Index (FSI) as developed by Laor et al. which included a number of vital sign data as well as laboratory values collected at admission in the emergency room. RESULTS: The average FSI was 9.1 ranging from 0 to 15. The mean FSI of survivors was 8.6 versus 12.4 of non-survivors. The surgical management of this disease process was also critically examined. The average number of repeated debridements was 3.5 ranging from 1 to 8. Both the FSI and the number of debridements were attempted to be used to predict outcome. Outcome was measured in the variables length of stay (days) and survival. A regression analysis revealed the number of debridements to be positively related to the length of stay (LOS). This was the opposite as expected at the beginning of the study. Also FSI was not predictive of LOS. CONCLUSIONS: Fournier's gangrene is a disease process with a wide variability in presentation. The FSI does give some indication about the likelihood of survival based on variables which can be recorded upon presentation. It also provides an efficient way to characterize the acuity of presentation and compare patients. While the repeated nature of debridements may be considered the accepted standard of care in these patients, this was not found to be predictive of outcome.     

Is Fournier's gangrene severity index useful for predicting outcome of Fournier's gangrene?

OBJECTIVES: Fournier's gangrene (FG) is a rare but life-threatening disease. Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the mortality rate remains high. We conducted a retrospective study to analyze the outcome and identify the risk factors and prognostic indicators. METHODS: We retrospectively reviewed the medical records of 25 patients diagnosed with FG between July 1993 and August 2003. Data collected included age, predisposing factors, treatment modalities, length of hospital stay, surgical debridement times, and outcome. The FG severity index was used to predict outcome. Univariate analysis of the different prognostic factors was performed using t test and Fisher's exact probability test. RESULTS: All patients were male, 60% were diabetic, and the mean age was 55.8 years. The mean hospital stay was 20 days and the mortality rate was 32%. The mean age of 53.8+/-18.3 (SD) years in the survival group (n=17) was significantly lower than the 59.9+/-10.2 years (n=8) of the non-survival group (p<0.05). Non-survival group patients had lower serum hematocrit (mean 28.9, p=0.019) and albumin (mean 1.93, p=0.024) levels. In our series, the mean FG severity index for survivors was 4.41+/-2.45 (range 2-9) compared to 12.75+/-2.82 (range 9-18) for those who died (t test, p<0.0001). CONCLUSION: The survival rate of younger patients with FG was higher. We agree that a FG severity index cutoff value of 9 is an excellent predictor of outcome.     

Fournier's gangrene: a retrospective clinical study on forty-one patients

BACKGROUND: Fournier's gangrene, first described by Dr Jean Alfred Fournier in 1883, still has a high mortality rate. The prognosis and outcome of such patients were analysed. METHODS: Forty-one patients with Fournier's gangrene were reviewed on the parameters of age, sex, aetiological agents, predisposing factors, treatment modalities and outcomes. RESULTS: Although early intervention and careful treatment was carried out, nine of 41 patients (21.9%) died as a result of complications of septicemia. Among the treatment modalities, there were extensive debridement, drainage, excisions of the skin and fascia, colostomy procedure, extensive antibiotic treatment and hyperbaric oxygen therapy. Although a combination of different treatment modalities were used, the mortality rate was 21.9%. CONCLUSIONS: Fournier's gangrene is still a severe disease. Today, hyperbaric oxygen treatment is very effective in the treatment of this disease.     

Fournier's gangrene: Three years of experience with 20 patients and validity of the Fournier's Gangrene Severity Index Score

OBJECTIVE: To evaluate effective factors in the survival of patients with Fournier's gangrene (FG) and to determine the validity of the Fournier's Gangrene Severity Index (FGSI), which was designed for determining disease severity in these patients. METHODS: The study included 20 men with a median age of 63.5 yr treated for FG between July 2002 and June 2005. The data were evaluated about medical history, symptoms, physical examination findings, vital signs, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic treatment used. All the patients had radical surgical debridement. The FGSI, which was developed to assign a numerical score that describes the acuity of the disease, was used in our study. This index presents patients' vital signs (temperature, heart and respiratory rates) and metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, hematocrit, white blood cell count) and computes a score relating to the severity of the disease at that time. The data were assessed according to whether the patient survived or died. RESULTS: Of the evaluated 20 patients, 6 died (30%) and 14 survived (70%). The difference in age between survivors (median age, 60.0 yr) and those who died (median age, 64.5 yr) was not significant (p = 0.321). The median extent of the body surface area involved in the necrotizing process in patients who survived and did not survive was 2.3% and 4.8%, respectively (p = 0.001). Except for the albumin and alkaline phosphatase levels, no significant differences were found between survivors and who those died in the other admission laboratory parameters. The median admission FGSI scores for survivors and nonsurvivors were 2.0+/-2.2 and 4.0+/-3.7, respectively (p = 0.331). CONCLUSIONS: The FGSI score did not predict the disease severity and the patient's survival. Metabolic parameters, predisposing factors, and extent of the disease seemed to be important risk factors for predicting FG severity and whether or not a patient survived.     

Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition,diagnosis, and treatment

Fournier's gangrene is an infectious necrotizing fasciitis of the perineum and genital regions. It is a synergistic infection caused by a mixture of aerobic and anaerobic organisms. The mortality rate from this infection ranges from 0 to 67 per cent. One of the most important determinants of overall outcome is early recognition and extensive surgical debridement upon initial diagnosis. This is followed by aggressive antibiotic therapy combined with other precautionary and resuscitative measures. Our hypothesis is that early aggressive surgical debridement combined with broad-spectrum antibiotic coverage results in decreased mortality from Fournier gangrene. The objective of this study was to determine our morbidity and mortality as compared with other institutions. This was a retrospective review of 200 charts of patients from 1990 through 2001. The charts reviewed included patients with a diagnosis of male and female genital abscesses, cellulitis, necrotizing fasciitis, and vascular disorders. This resulted in 33 patients who had a final diagnosis of Fournier's gangrene. There were 26 (79%) males and seven (21%) females with a diagnosis of Fournier's gangrene. The patients ranged in age from 30 to 85 years (mean age 51.5). There were a number of predisposing factors that were examined. Thirteen patients (39%) were diabetic, 18 (55%) suffered from hypertension, 18 (55%) were obese, and 18 (55%) were cigarette smokers. Four patients (12%) had no predisposing factors. The treatment consisted of wide surgical debridement which was performed in all 33 patients. Most patients received multiple debridements ranging from one surgery to seven (mean 3.25) per hospital stay. The majority of patients received broad-spectrum antibiotic coverage. Three patients died, which resulted in a mortality rate of 9 per cent. Early recognition and aggressive surgical debridement is the most essential intervention in stopping the rapidly progressing infectious process of Fournier's gangrene. This intervention should be combined with aggressive triple-antibiotic therapy and other precautionary measures for supporting the patient who has the systemic effects of Fournier's gangrene. Our data do not reach statistical significance with regard to the use of triple-antibiotic therapy. However, we believe that it is an important part of the treatment regimen. The combination of aggressive surgical therapy and appropriate antibiotic coverage results in a reduction in mortality.     

The evolving characteristics and care of necrotizing soft-tissue infections

BACKGROUND: Necrotizing soft-tissue infections such as necrotizing fasciitis and Fournier's gangrene are a source of high morbidity and mortality. These difficult cases are increasingly being referred to burn centers for specialized wound and critical care issues. In this study, we examine our institution's recent experience with a large series of necrotizing soft-tissue infections. STUDY DESIGN: A retrospective chart review was performed of 65 consecutive patients over a 5-year period with necrotizing soft-tissue infections that required radical surgical debridement. RESULTS: Overall survival was 83%, with an average length of stay of 32.4+/-3.32 days for survivors and for the entire group of 29.5+/-3 days. Time from onset of symptoms to initial presentation to our institution averaged 6.9+/-1.19 days. Patients averaged 2.9+/-0.22 surgical procedures, and 46% of patients required skin grafting with an average graft area of 1554+/-248 cm(2). Of the survivors, only 54% were able to return home, with 46% needing further hospitalization or transfer to an inpatient rehabilitation facility. CONCLUSIONS: There were frequent delays in diagnosis and referrals to and from within our institution, and progress can be made in educating the medical community to identify these patients. Advancements in wound care and critical care have made inroads into the treatment of patients with necrotizing soft-tissue infections. However, these infections continue to be a source of high morbidity and mortality and significant healthcare resource consumption. These challenging patients are best served with prompt diagnosis, immediate radical surgical debridement, and aggressive critical care management. Referral to a major burn center may help provide optimal surgical intervention, wound care, and critical care management.     

Necrotising perineal infection: a fatal outcome of ischiorectal fossa abscesses

INTRODUCTION: Necrotizing perineal infection or Fournier's gangrene is an uncommon but lethal complication of ischiorectal fossa abscesses. It is associated with a high mortality, especially in diabetics and immunocompromised individuals. Attempts have been made to study factors which could serve as prognostic indicators. The role of faecal diversion has not been clearly determined. MATERIALS AND METHODS: The medical records of 8 patients who presented with necrotizing perineal infection as a complication of ischiorectal fossa abscesses were reviewed. Various parameters were studied to see if any of them could serve as predictors of outcome. Mean surface area of involvement was calculated using modified burns assessment criteria. To study the effect of colostomy on the general condition of the patient the physiological and biochemical parameters before and after the procedure were compared. Statistical analysis was done using the unpaired and paired 't' tests. RESULTS: The mean age of the patients was 50.6 +/- 10.3 years. Five patients were diabetic, of whom four died; all the non-diabetics survived. The mean surface area of involvement was 5.1 +/- 0.75%, among the survivors, and 9.6 +/- 3.4% among the non-survivors. Colostomy was performed in four patients one of whom died. While in one patient the colostomy was created along with the initial radical debridement, in three other patients it was formed on days three, five and five, respectively. There was a significant improvement in their general status and biological parameters. All patients with testicular involvement died. CONCLUSION: Evidence of systemic sepsis at presentation, extent of tissue and testicular involvement, a low haematocrit, a high blood urea and creatinine and a low serum albumin, were associated with a higher mortality. Prompt recognition of the condition, urgent radical surgical debridement and the use of appropriate antibiotics are the mainstays of management. Formation of a diverting colostomy appears to favour survival.     

The continuing challenge of Fournier's gangrene in the 1990s

Fournier's disease is a potentially fatal acute, gangrenous infection of the scrotum, penis, or perineum associated with a synergistic bacterial infection of the subcutaneous fat and superficial fascia. Thrombosis of small subcutaneous arterioles with resultant ischemia contributes to the rapid extension of the infection. During a 12-year period, the clinical and operative records of 14 patients with Fournier's gangrene were analyzed. All patients were treated with broad spectrum antibiotics and serial surgical debridements. Nine patients had polymicrobial isolates from the initial wound culture; two patients had Group A Streptococcus species as the sole isolate. The etiology of the infection was identified in 12 patients. Five patients died for an overall mortality of 38 per cent. The mean age of survivors was 51 years compared with 75 years for nonsurvivors (P<0.05). The last six patients in this series survived. The mean hospital stay was 29 days. Four patients (31%) had a prior history of diabetes; however, 11 patients (85%) had elevated serum glucose levels (>120 mg/dL) on admission. All patients were hypoalbuminemic on admission. Survivors had an average serum creatinine on admission of 1.28 mg/dL compared with 3.1 mg/dL for nonsurvivors. Although supportive care is required in these patients, the mainstay for treatment of Fournier's gangrene entails an aggressive approach with frequent and extensive soft tissue debridements to control the invasive nature of the infection with delayed wound coverage once the infection has been controlled. Elderly patients with evidence of renal dysfunction on admission have a poor prognosis despite aggressive therapy.     

Predisposing factors and treatment outcome in Fournier's gangrene. Analysis of 28 cases

OBJECTIVES: To evaluate the etiologic factors and the effects of surgical debridement and adjunctive therapies on morbidity and mortality of Fournier's gangrene. METHODS: 27 males, 1 female, a total of 28 patients with a mean age of 58 years treated for Fournier's gangrene were evaluated retrospectively. RESULTS: Predisposing factors including diabetes, alcohol abuse, paraplegia and renal insufficiency were identifiable in 54% of the patients. Etiologic origin of the gangrene was urogenital, cutaneous and anorectal in 43, 25 and 11% of the patients, respectively. The pathology was limited to genitalia in 10, extending to perineum in 8, the umbilicus in 7 and even up to the axilla in 3 patients. Suprapubic cystostomy and colostomy were necessary in 18 and 2 cases, respectively. We used hyperbaric oxygen therapy in 2 and honey in 6 patients to accelerate wound healing. A repeat debridement was necessary in 39% of the cases. Plastic surgery and grafting were done in 14 patients. Our mortality rate was 7%. CONCLUSION: Early recognition of the pathology and aggressive surgical debridement are the mainstay of the management of Fournier's gangrene. Additional strategies to improve wound healing and increase patient survival are also needed.     

暴发性阴囊坏疽的局部处理方法探讨

目的 探索暴发性阴囊坏疽的治疗方法。方法 回顾分析9例暴发性阴囊坏疽治疗方案。9例患者均行外科清创，冲洗引流，抗感染等治疗，其中4例感染广泛蔓延的患者清创术后，采用U形多孔双向引流管引流。3例外暴露的睾丸暂置于浅表腔隙中，二期重建阴囊回纳睾丸。结果 留置U形管引流者，重复清创手术的次数明显减少，体温及血象恢复正常的时间较普通引流显著缩短，术后恢复迅速。结论 暴发性阴囊坏疽的治疗仍以清创及应用抗生素为主，术中多毋须切除睾丸。U形多孔双向引流管在清创术后引流效果确切，在促进康复有明显优势。     

Impact of immunodeficiency virus (HIV) on Fournier's gangrene: observations in Zambia.

The results of a prospective study in the University Teaching Hospital, Lusaka, Zambia, on the impact of Human Immunodeficiency Virus on the incidence and prognosis of Fournier's gangrene is presented; Zambia has been in the grip of an HIV epidemic since the early 1980s. A total of 10 patients with an average age of 32 years was observed during a 14-month period (March 1992-April 1993); eight patients had associated HIV infection. A contributory factor to the development of Fournier's gangrene was also present in seven patients, of which six involved the urinary tract. All patients were managed by early surgical débridement under antibiotic cover. Two patients died, only one of whom had associated HIV disease. This study has recorded a significant rise in the prevalence of Fournier's gangrene in Zambia since the advent of the HIV epidemic. It has also been documented that provided aggressive treatment along established lines is initiated without delay, the coexisting HIV infection does not adversely affect the prognosis of Fournier's gangrene.     

Management of Fournier's Gangrene: Review of 45 Cases

Purpose Fournier's gangrene is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and the vulva in women. Methods The clinical and operative records of 45 patients with Fournier's gangrene during a 14-year period were analyzed. Results The etiology of the infection was identified in 39 patients. The most common causes were colorectal diseases and urogenital diseases. Four patients died with an overall mortality of 8.8%. The mortality rate was higher in patients with diabetes mellitus, but it was not statistically different. The age, duration of the symptoms, and the presence of rectal abscess were not found to be significant factors regarding mortality rate. Conclusions Surgery with extensive debridement of all necrotic tissue is the main stay of treatment.     

A case of Fournier's gangrene reconstructed using a rectus abdominis muscle flap

We encountered a case of Fournier's gangrene complicated with vesicorectocutaneous fistula that was treated with a pedicled rectus abdominis muscle flap (pedicled RA m-c flap). A 75-year-old man was admitted with consciousness disorder and swelling of the scrotum. The patient had noticed swelling of the scrotum 4 days before admission, but he had ignored this condition. The scrotum and the penis appeared necrotic. On the basis of clinical and radiological findings, we diagnosed this condition as Fournier's gangrene. Surgical debridement was performed in conjunction with the use of broad-spectrum antibiotics. After the patient's general condition was improved, the broad defect in the perineal tissue was covered with a pedicled rectus abdominis muscle flap. The flap was successful. In Japan, this is the first case of Fournier's gangrene complicated with vesicorectocutaneous fistula that was treated with a pedicled RA m-c flap. In order to determine whether plastic surgery after debridement shortens the duration of hospitalization, we reviewed the cases of 120 patients with Fournier's gangrene in Japan. We conclude that plastic surgery after debridement does not shorten the duration of hospitalization, however, this procedures is very useful to deep and broad defects by Fournier's gangrene.     

Fournier's gangrene: 5 patients treated with hyperbaric oxygen

The classic syndrome of Fournier's gangrene was observed in 5 men with involvement of the external genitals and lower abdominal wall. Mixed flora of anaerobic and aerobic microorganisms were grown, and extensive necrosis of the skin and subcutaneous gas were present in all patients. Soon after hospitalization all 5 patients were treated by excision of all necrotic and undermined tissue, intravenous broad-spectrum antibiotics and hyperbaric oxygen administered at 3 atmospheres of pressure. One patient died of septic shock without any response to the therapy. The infection subsided shortly after the hyperbaric oxygen was instituted in the remaining 4 patients, who were cured. It is proposed that the treatment of Fournier's gangrene should be limited to centers capable of administering hyperbaric oxygen therapy. Our series does not prove that hyperbaric oxygenation is necessary for successful treatment but evidence suggests a beneficial effect of such therapy for nonclostridial gas gangrene.     

Fournier's gangrene: diagnostic approach and therapeutic challenge.

OBJECTIVE: To identify the prognostic variables and to assess the role of aggressive management in patients with Fournier's gangrene. DESIGN: Retrospective study. SETTING: University hospital, Greece. SUBJECTS: 11 patients (9 men and 2 women) with Fournier's gangrene admitted between April 1986 and December 2000. INTERVENTIONS: Early aggressive debridements. MAIN OUTCOME MEASURES: Postoperative course, hospital stay, outcome, morbidity, and mortality. RESULTS: The mean age was 65 years (range 17-90) and the mean (SD) duration of hospital stay was 35 (8) days (range 8-62). The aetiology was identified in 8 patients and idiopathic in 3. Predisposing factors (diabetes, n = 4; heart failure, agranulocytosis, and alcohol misuse, n = 1 each) were identified in 6 patients. All patients except one had raised serum glucose concentrations and low serum albumin values. On admission the white cell count was >15 x 10(9)/L in 10, serum sodium <135 mmol/L, mean (SD) serum creatinine 124 (27) micromol/L, and C-reactive protein >150 mg/L was found in all patients. 3/9 male patients required partial excision of the scrotum. Temporary faecal diversion was done for 3 patients. A mean of 3 aggressive repeated debridements (range: 3-6) were required. Nine patients survived and two patients died. CONCLUSION: Rapid and accurate diagnosis remains the key to achieving a successful outcome. Abnormal laboratory variables on admission may suggest the diagnosis. Early, repeated, aggressive debridement is essential for a successful outcome.     

Fournier's gangrene. Report of three cases and review of the literature

Fournier's gangrene, or synergistic gangrene of the male external genitalia is a rapidly spreading necrotising infection of the penis and scrotum. Although not so frequent in our civilized world it is by no means rare. In early days it was characterised by a high mortality. Aggressive surgical debridement, broad spectrum antibiotics and plastic reconstructive technics have all contributed to a better survival of the patients.     

Systemic inflammatory response syndrome score at admission independently predicts infection in blunt trauma patients

BACKGROUND: Systemic inflammatory response syndrome (SIRS) score has been demonstrated to be an accurate predictor of outcome in critical surgical illness. To our knowledge, there is a paucity of data using SIRS score as a tool to predict posttraumatic infection. Our goal was to determine whether the severity of SIRS score at admission is an accurate predictor of infection in trauma patients. METHODS: Prospective data were collected on 4,887 blunt trauma patients admitted to a primary adult resource center designated trauma center over an 18-month period. Patients were stratified by age and Injury Severity Score (ISS). SIRS score was calculated at admission. SIRS was defined as an SIRS score > or = 2. Each patient was screened for infection by an infectious disease specialist. Those at high risk for infection were then monitored daily throughout their hospitalization. Centers for Disease Control and Prevention guidelines were used to diagnose infection. RESULTS: Of the 4,887 patients, 1,850 (38%) were admitted > 24 hours and evaluated for subsequent infection (mean ISS, 16 +/- 9; mean age, 43 +/- 19, SD). Thirty-one percent (577) of the patients acquired an infection. The mean hospital length of stay (20.2 days vs. 6.5 days) and mortality (7.8% vs. 2.7%) were significantly greater in the infected group (p < 0.001). Of the four SIRS variables (temperature, heart rate, white blood cell count, and respiratory rate), hypothermia and leukocytosis were the most significant predictors of infection (p < 0.001) when adjusted for age and ISS. SIRS scores of > or = 2 were increasingly predictive of infection when analyzed by multiple logistic regression analysis. CONCLUSION: An admission SIRS score of > or = 2 is a significant independent predictor of infection and outcome in blunt trauma. Daily SIRS scores may be a meaningful method of assessing postinjury risk of infection, and may initiate earlier diagnostic intervention for determination of infection.     

预后评分系统在Fournier坏疽诊治中的应用

目的 比较两种预后评分系统在我国Fournier坏疽患者死亡风险预测中的适用情况.方法 回顾性分析15例Fournier坏疽患者的临床特点及治疗转归,将研究对象分为存活组(A组)和死亡组(B组),并应用Fournier坏疽严重程度指数(FGSI)和Uludag FGSI进行死亡风险评估,采用受试者工作特征曲线(ROC)进行评分表效果评估,并利用Z检验比较FGSI和UFGSI之间准确性的差异.结果 存活组(A组)11例,死亡组(B组)4例.平均年龄(P =0.024)及术前美国麻醉师协会(ASA)评分(P =0.04)B组均显著高于A组.A组患者接受的清创次数明显多于B组患者.FGSI评分A组低于B组[(1.6±0.9)vs (3.8±1.7),P＜0.05].ROC曲线下面积(AUR) =0.886.UFGSI评分A组明显低于B组[(3.6±1.5)vs(6.0±2.2),P＜0.05],ROC AUR=0.852.UFGSI和FGSI的AUC比较差异无统计学意义.结论 FGSI和UFGSI均可有效预测我国Fournier坏疽患者的死亡风险,并且两种评分系统差异无显著统计学意义,但适合我国患者的死亡评估阈值还需要进一步大样本研究重新确定.     

Fibrin sealant for the reconstruction of fournier's gangrene sequelae

PURPOSE: We describe the use of fibrin tissue adhesive as an adjunct for reconstructing genital skin loss due to Fournier's gangrene. MATERIALS AND METHODS: We treated 2 patients with Fournier's gangrene with repeat surgical débridement and antibiotics. Delayed primary closure was enhanced by using liquid fibrin sealant. In 1 case the sealant was used to obliterate a large testicular thigh pouch that had become infected. In the other case it was used to anchor the under surface of a thigh flap for scrotal reconstruction. RESULTS: In each patient the fibrin tissue adhesive prevented further complications of Fournier's disease. CONCLUSIONS: Fibrin sealant is an effective adjunct for managing extensive genital skin loss caused by Fournier's gangrene.     

Hyperbaric oxygen for the treatment of fournier's gangrene

PURPOSE: Fournier's gangrene is a necrotizing fasciitis of the genitalia that is associated with high morbidity and mortality. Groups at many institutions have initiated routine adjuvant hyperbaric oxygen (HBO) therapy. We examined whether HBO has made a difference in the morbidity, mortality and costs associated with treating this disease. We also analyzed predictors of extended hospital stay and mortality. MATERIALS AND METHODS: The records of patients with the hospital discharge diagnoses of Fournier's gangrene, necrotizing fasciitis, gangrene of the genitalia and scrotal gangrene from 1993 to 2002 were reviewed. Data concerning clinical presentation characteristics, hospital stay, complications, hospital charges and outcomes, including graft failure and death, were analyzed. RESULTS: A total of 42 patients were identified and followed a median 4.2 years. Of the patients 16 underwent surgical debridement and antibiotic therapy alone, and 26 were treated with HBO plus surgery and antibiotics. Overall disease specific mortality was 21.4%, that is 12.5% in the nonHBO group and 26.9% in the HBO group. Three or more complications occurred in 13% of nonHBO and in 19% of HBO cases, of which the most common was myocardial infarction. The skin graft failure rate was 6% (nonHBO) and 8% (HBO). Physical disability was a statistically significant predictor of extended hospital stay (p <0.01). There was a trend toward a correlation between known coronary artery disease and death (p = 0.2). A statistically significant difference was noted in average daily hospital charges in nonHBO vs HBO cases ($2,552 vs $3,384 daily, p <0.01). CONCLUSIONS: These data do not support routine HBO in the treatment of Fournier's gangrene. There was a trend toward higher morbidity and mortality in the HBO group, suggesting that treatment may have been given to patients who were more ill.