Fournier's gangrene and its emergency management

Abstract

Fournier's gangrene (FG) is a rare but life threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as long term alcohol misuse; however, it can also affect patients with non-obvious immune compromise. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract, or skin. FG is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the death rate remains high.

Pressure sores significantly increase the risk of developing a Fournier's gangrene in patients with spinal cord injury

“…2,11,12 The aim of our study was to analyze and describe the risk factors in patients with SCI and Fournier's gangrene. In addition, the type of the pathogen was also determined, as there has been reported a different bacterial spectrum in patients with SCI.…”

Fournier’s Gangrene

“…The local signs and symptoms are usually dramatic with significant pain and swelling. The patient also has pronounced systemic signs; usually out of proportion to the local extent of the disease [9].…”

“…One important challenge after extended surgery is the closure of the skin defect. Skin greft is a choice for the management of skin defecets however the use of Vacuum Assisted Closure [VAC] system dressing has been reported to successfully minimise skin defects , speed tissue healing and decrease the need for skin grefting [9].…”

Severe necrotizing infection of the perineum: beyond necrosectomy

“…Upon diagnosis, the disease also warrants an aggressive multimodal approach, which includes hemodynamic stabilization and broad spectrum antibiotics (3). This management strategy may assist to stem the transition to multiple organ dysfunction and mortality.…”