Fournier’s Gangrene: Current Practices

Fournier’s gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20–30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes. 1. Introduction Fournier’s gangrene (FG) is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children [1]. In 1764, Baurienne originally described an idiopathic, rapidly progressive soft-tissue necrotizing process that led to gangrene of the male genitalia. However, Jean-Alfred Fournier, a Parisian venereologist, is more commonly associated with this disease, which bears his name. In one of Fournier’s clinical lectures in 1883, he presented a case of perineal gangrene in an otherwise healthy young man. Since Fournier’s description, subsequent experience has shown that, in most cases, Fournier gangrene has an identifiable cause and that it frequently manifests more indolently. Over the years several terms have been applied to Fournier’s gangrene including “streptococcus gangrene,” “necrotising fasciitis,” “periurethral phlegmon,” “phagedena,” and “synergistic necrotising cellulitis”. Early surgical debridement (as shown in Figure 1) of necrotic tissues and antibiotics are fundamental in the treatment of FG. Despite advanced management mortality is still high and averages 20–30% [2]. In a review of 1726 cases from 1950 to 1999 worldwide, reported in the English literature, the mortality rate was 16 per cent. In a subsequent unpublished study of 3297 cases of FG from 1950 to 2007, the