Clinical Profile, Microbiological Characteristics, and Surgical Management of Fournier's Gangrene: A Retrospective Case Series from a Tertiary Care Centre in North Maharashtra

Background: Fournier’s gangrene (FG) is a rapidly progressive necrotizing soft-tissue infection involving the external genitalia, perineum, and perianal region. Early recognition, prompt surgical debridement, appropriate antimicrobial therapy, and supportive management are essential to improve clinical outcomes. This study aimed to describe the clinical profile, predisposing conditions, microbiological findings, surgical management, and outcomes of patients with Fournier’s gangrene treated at a tertiary care centre in North Maharashtra. Methods: This retrospective observational case series included 14 patients diagnosed with and treated for Fournier’s gangrene at SMBT Medical College and Research Centre, Igatpuri, Nashik, Maharashtra, between January 2022 and January 2024. Demographic characteristics, comorbidities, anatomical involvement, complications, bacterial culture findings, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores, and surgical management were reviewed. Descriptive statistical methods were used to summarize the available data. Results: Fourteen patients were included, comprising 13 males (92.9%) and one female (7.1%), with a male-to-female ratio of 13:1. The mean age was 58.1 years, the median age was 59.5 years, and the age range was 26–85 years. Diabetes mellitus was the most frequently recorded comorbidity, affecting seven patients (50%). Scrotal involvement was observed in ten patients (71.4%), including those with additional penile involvement. Three patients (21.4%) had involvement of both the genital and perineal regions, while one female patient (7.1%) had isolated perineal involvement. Seven patients (50%) developed complications, including sepsis in three (21.4%), renal failure in two (14.3%), heart failure in one (7.1%), and pneumonia in one (7.1%). Bacterial cultures were positive in 11 patients (78.6%), with Escherichia coli being the most frequently isolated organism, identified in eight patients (57.1%). The mean LRINEC score was 8.43 (range: 6–11). All patients underwent emergency surgical debridement. Primary closure was performed in one patient, skin grafting in one patient, and healing by secondary intention in 12 patients. Colostomy was performed in two patients, while suprapubic catheterization was performed in three patients. No in-hospital mortality was reported in this series. Conclusion: Fournier’s gangrene is a serious surgical emergency requiring prompt diagnosis, broad-spectrum antimicrobial therapy, early surgical debridement, and appropriate supportive care. Diabetes mellitus was the most common associated comorbidity in this series. Individualized wound management and reconstructive procedures were used according to the extent of tissue involvement. The findings highlight the importance of early multidisciplinary management, although the small sample size and retrospective design limit the generalizability of the results.