Challenges, terms, and conditions of nursing Fournier’s gangrene in a semi-urban hospital: experience of the Aného Prefectural Hospital Centre in Togo

Abstract

Introduction: Fournier’s gangrene (FG) is a rare perineogenital necrotising fasciitis with a serious prognosis. Its initial early nursing is based on resuscitation and debridement, which guarantees a good prognosis. However, it is challenged by delayed consultation or a lack of specialists in semi-urban areas.

Aim: Take up the challenges and describe the nursing terms and conditions of FG in a semi-rural environment at the Aného Prefectural Hospital Centre (PHC).

Method: This was a prospective and descriptive study over five years of patients treated for FG at the general surgery department of the Aného PHC, with a minimum follow-up of four months. The parameters studied were anatomo-clinical, therapeutic, and prognostic.

Results: We collected 13 cases of FG, all men, out of 4 127 patients over five years. The average period for admission was 15.15 ± 7.92 days (6–32). Perineoscrotal lesions were noted in eight cases, scrotal in three, and penoscrotal in two. All patients received broad-spectrum antibiotic therapy tailored to their ailment. Debridement under caudal anaesthesia (11 cases) and general anaesthesia (two cases) was performed in all patients. Two patients underwent a colostomy. The follow-up dressings in the ward were moist dressings, leading to four cases of directed healing, two skin grafts, and five medial thigh fasciocutaneous flaps with immediate closure of the donor sites. The average reconstruction period was 33.01 ± 16.08 days (24–68). The average period of hospitalisation was 49.69 ± 26.99 days (21–102). The evolution was uncomplicated in nine patients; two patients presented complications after the reconstructions, and two deaths were recorded.

Conclusion: Improving the prognosis of FG in semi-urban environments requires awareness to avoid consultation delays and the provision of more specialists.