Fournier's gangrene: A general surgery problem

Abstract

Fournier's gangrene is a specific form of synergistic gangrene involving the scrotum and perineum. The disease may follow a variety of clinical conditions or occur without an apparent precipitating cause. It is associated with severe systemic toxicity and a significant mortality rate, and it demands prompt recognition and urgent, aggressive surgical intervention. Its treatment calls on the full armamentarium of the general surgeon. Preoperative resuscitation is often required. Operative debridement can be extensive, involving the buttocks and on occasion the upper thighs and abdominal wall. Postoperative management consists of wound care with eventual grafting or flap rotations. Colostomy may be required. Three cases illustrating the salient features of this disease are presented, together with a review of the literature.

The clinical features of Fournier’s gangrene and the predictivity of the Fournier’s Gangrene Severity Index on the outcomes

“…Median duration time of symptoms before presentation was statistically significant between patients who survived and those who died-3 [3][4][5][6][7][8][9][10][11][12][13] and 11 [7][8][9][10][11][12][13][14][15][16] days, respectively (P \ 0.001, Table 3). …”

Fournier’s gangrene: Exists and it is still lethal

“…Its anatomical and clinical features are well defined and the portals of entry of causative organisms are well known [1,2]. Although idiopathic cases were reported as accounting for 26% [3] or 50% [4] in the 1980s, our search in the literature limits them currently to approximately 10%. Fournier's gangrene is probably the same disease as necrotizing fasciitis, which occurs in other parts of the body, but modified by the peculiar anatomy of the genitoperitoneum [5].…”

Necrotizing Fasciitis of the Perineum and the Abdominal Wall-Surgical Approach

“…While some authors have condemned these measures [46] most authors advocate their application in appropriate circumstances [47][48][49]. Like others [32,50] we estimate colostomy or ileostomy mandatory in cases in which the infection affects the anorectal region, especially when extended perianal excision has to be performed.…”

“…While there are reports on spontaneous healing using dressing alone [57][58][59], other authors insist on avoiding spontaneous healing because it can lead to further complications [47,86], requiring additional reconstructive procedures [72,87]. Although the inflammatory process usually affects the borderlines to healthy organs, testicular abscess and gangrene on the one hand, or penis gangrene on the other hand may result in loss of testes and penis in few patients [88][89][90][91].…”