Reconstructive Outcomes of Fournier's Gangrene: A Multi-center Five-Year Retrospective Study at ALERT and Yekatit 12 Specialized Hospitals, Addis Ababa
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Date
2025-01-08
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Addis Ababa University
Abstract
Background:
Fournier's Gangrene (FG) is a fulminant necrotizing fasciitis with high mortality and morbidity. In Ethiopia, data on reconstructive outcomes are scarce. This study evaluates the reconstructive outcomes and determinants of surgical success in FG patients.
Method:
multi-center retrospective cohort study was carried out at ALERT and Yekatit 12 Hospitals (August 2020–September 2025). All patients who underwent reconstruction following FG debridement were included. Data on demographics, comorbidities, reconstructive techniques, and outcomes were collected. Success was defined as >90% graft/flap survival without urgent revision. Analysis used SPSS v26 with descriptive statistics and bivariate tests.
Results:
Among the 32 patients included, median age was 49 years (interquartile range 39–54), with 96.9% males. Common comorbidities were diabetes (12.5%), hypertension (18.8%), and HIV (3.1%). Reconstructive methods included split-thickness skin grafts (25.0%), delayed closure (28.1%), regional flaps (21.9%), and combination techniques (25.0%). The overall success rate was 78.1%. Factors associated with poor outcomes included a higher SFGSI score (p=0.016) and use of regional flaps alone (p<0.001). Complication rate was 21.9%, with flap necrosis (85.7% of failures) and graft failure (12.5% of failures) most common.
Conclusion:
In our experience regional flaps alone had a high complication rate (85.7%), whereas combination techniques and simpler methods achieved excellent success. Surgical methods that were simpler and less technically demanding had higher likelihood of success with limited complications.
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Keywords
Fournier's Gangrene, necrotizing fasciitis, reconstruction, skin graft, flap, Ethiopia, surgical outcomes