Fournier's gangrene

Abstract

Fournier's gangrene is the result of a highly lethal and rapidly progressive necrotizing infection of the perineal and genital fascia, with gangrene of the overlying skin. The infection is generally polymicrobial and probably synergistic in nature. Anorectal, genitourinary, and traumatic infections are the most common causes of Fournier's gangrene. The cutaneous manifestations of Fournier's gangrene are merely "the tip of the iceberg" because the infection spreads aggressively along recognized fascial planes. Perioperative fluid resuscitation, cardiopulmonary support, antibiotic therapy, and nutritional support are of major importance in management of the disease; however, examination under anesthesia with aggressive surgical débridement remains the most important aspect of treatment. Multiple surgical procedures may be necessary to bring the infection under control. In the majority of instances, the testes, glans penis, bladder, and rectum are spared destruction because of their separate blood supplies. Diversion of the fecal and urinary streams may not always be necessary but should always be considered on a case-by-case basis. The value of hyperbaric oxygenation in Fournier's gangrene remains unproven, but there are theoretical reasons why it may be beneficial, at least in some cases. Despite optimal medical and surgical management, the mortality rate in Fournier's gangrene still exceeds 40% in many series.