Mert Can RADOR, Ahmet Can TUZLUKLU, Gaye FİLİNTE, Kaan GİDEROĞLU, Alperen KAHRAMAN, Bilal ERYILDIRIM, Hasan Fehmi KÜÇÜK
Turkish Journal of Medical Sciences - 2026;56(5):1476-1487
Background/aim: Necrotizing soft tissue infections are uncommon but rapidly lethal, and their perineal form, Fournier's gangrene, is most often referred for reconstruction. Whether routine admission findings identify the highest-risk patients more accurately than severity scores remains uncertain, and whether sodium-glucose cotransporter-2 (SGLT-2) inhibitors, which are widely used in patients with diabetes, influence clinical outcomes also remains unclear. Materials and methods: We retrospectively studied consecutive adults with necrotizing soft tissue infection at a tertiary referral center over 5 years. A subcohort of 70 patients who underwent plastic and reconstructive surgery was identified within the full institutional cohort of 137. Admission findings were compared according to in-hospital mortality, the ability of severity scores to discriminate mortality was evaluated, and, among patients with diabetes, SGLT-2 inhibitor exposure was explored in relation to clinical outcomes. Results: Fournier's gangrene predominated (85.7%), and 85.7% had diabetes. In-hospital mortality was 18.6% in the reconstructive subcohort and 21.9% in the overall institutional cohort; 41.4% of patients required intensive care, and the median hospital stay was 18 days. Lower admission serum albumin levels, a higher C-reactive protein-to-albumin ratio, and septic shock were associated with in-hospital mortality (all p < 0.001), whereas the LRINEC and SIARI scores and the neutrophil-to-lymphocyte ratio did not discriminate mortality. After early radical debridement, the resulting defects were reconstructed according to the reconstructive ladder, ranging from skin grafting to local/regional and free flap reconstruction. Among patients with diabetes, SGLT-2 inhibitor exposure was not associated with in-hospital mortality (15.2% versus 19.6%; p = 0.78) or intensive care unit admission. Conclusion: Severity scores aid diagnosis, whereas admission biochemical and physiological parameters provide prognostic information, helping identify patients at the highest risk who may benefit from early triage. Once debridement achieved source control, flaps were the mainstay for closing the perineogenital defects. Because our analysis included only patients who had already developed the disease, it addresses outcomes rather than incidence or causation. SGLT-2 inhibitor exposure was not associated with worse outcomes; however, this hypothesis-generating finding does not establish safety.
