There is no consensus about the role of adjunctive hyperbaric oxygen therapy (HBOT) in the management of Fournier\'s gangrene. The aim of this study was to compare the evolution of patients with Fournier\'s gangrene treated with all classical measures with and without adjuvant HBOT. A retrospective comparative study regarding the evolution of patients treated for Fournier\'s gangrene was conducted in two periods. In period I, from 1990 to 2002, patients received standard treatments for Fournier\'s gangrene, which consisted of surgical debridement, antibiotic therapy and intensive care. In period II, from 2012 to 2019, adjunctive HBOT was added to the classical management strategy. All patients were assigned into four groups according to the anatomical severity classification and the area affected after the first debridement. This classification ensured that the groups could be comparable. The total number of patients in this study was 197, and these patients were divided into control group (118/59.9%) and HBOT group (79/40.1%). The mean age, comorbidities, and anatomical severity classification were similar between the two groups. In period I, 34 out of 118 (28.8%) patients died, while in the HBOT group, 3 out of 77 (3.7%) patients died (P < 0.001). The use of adjuvant HBOT in combination with classical treatment was associated with reduced mortality. This study was approved by the Institutional Review Board and the Ethics Committee of Ribeirão Preto Medical School, University of São Paulo, Brazil (No. 08/2018) on May 2, 2018.

暂无摘要。

BACKGROUND: Multifocal necrotizing fasciitis is a condition in which there is more than one non-contiguous body area affected, and it is usually the result of the dissemination of septic emboli.
METHODS: We present a 67 year-old patient, on oral corticosteroid treatment, who was admitted with a septic shock. The previous week he had been operated on due to the perforation of a colon diverticulum. He had signs that suggested necrotizing fasciitis on all four limbs which progressed quickly. Emergency fasciotomies on all limbs were performed, and empirical antibiotic treatment was started.
RESULTS: After the surgery the patient improved, and seven days after the debridement, primary closure of the wounds was performed. Tissue cultures were negative.
CONCLUSIONS: Being a rare entity, there is no consensus regarding the management of multifocal necrotizing fasciitis. However, early and aggressive debridement (including fasciotomies and even amputation) and broad-spectrum antibiotics are essential for its treatment.