Abstract
Effective early treatment of this serious condition is necessary to prevent death. Urgent exploration by the most experienced surgeon available should include wide excision of all necrotic or dubious tissue, and adequate drainage of deep fascial planes. Deep and apparently healthy tissues must be exposed and the surgeon must be prepared to proceed to laparotomy, and even diverting colostomy and/or suprapubic cystotomy when necessary. Cross matched blood must be available, and we have found hydrogen peroxide irrigation useful. Pus, tissues, and blood samples for bacteriological culture and sensitivity should always be sent, but broad spectrum antibiotics should be started without delay to prevent systemic complications. In addition to the urgent initial surgery, repeated daily examination of all wounds is necessary, usually under general anaesthesia to allow full inspection, further débridement, irrigation and change of dressings, until the infective process is halted. This is a serious condition with a high mortality which we believe may be reduced by early diagnosis and appropriate aggressive surgery.
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- Bahlmann J. C., Fourie I. J., Arndt T. C. Fournier's gangrene: necrotising fasciitis of the male genitalia. Br J Urol. 1983 Feb;55(1):85–88. doi: 10.1111/j.1464-410x.1983.tb07087.x. [DOI] [PubMed] [Google Scholar]
- Bjornson H. S., Hill E. O. Bacteroidaceae in thromboembolic disease: effects of cell wall components on blood coagulation in vivo and in vitro. Infect Immun. 1973 Dec;8(6):911–918. doi: 10.1128/iai.8.6.911-918.1973. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Burpee J. F., Edwards P. Fournier's gangrene. J Urol. 1972 May;107(5):812–814. doi: 10.1016/s0022-5347(17)61146-7. [DOI] [PubMed] [Google Scholar]
- Ingham H. R., Sisson P. R., Tharagonnet D., Selkon J. B., Codd A. A. Inhibition of phagocytosis in vitro by obligate anaerobes. Lancet. 1977 Dec 17;2(8051):1252–1254. doi: 10.1016/s0140-6736(77)92662-9. [DOI] [PubMed] [Google Scholar]
- Jamieson N. V., Everett W. G., Bullock K. N. Delayed recognition of an intersphincteric abscess as the underlying cause of Fournier's scrotal gangrene. Ann R Coll Surg Engl. 1984 Nov;66(6):434–435. [PMC free article] [PubMed] [Google Scholar]
- Jones R. B., Hirschmann J. V., Brown G. S., Tremann J. A. Fournier's syndrome: necrotizing subcutaneous infection of the male genitalia. J Urol. 1979 Sep;122(3):279–282. doi: 10.1016/s0022-5347(17)56367-3. [DOI] [PubMed] [Google Scholar]
- Lamerton A. J. Fournier's gangrene: non-clostridial gas gangrene of the perineum and diabetes mellitus. J R Soc Med. 1986 Apr;79(4):212–215. doi: 10.1177/014107688607900408. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ledingham I. M., Tehrani M. A. Diagnosis, clinical course and treatment of acute dermal gangrene. Br J Surg. 1975 May;62(5):364–372. doi: 10.1002/bjs.1800620510. [DOI] [PubMed] [Google Scholar]
- Oh C., Lee C., Jacobson J. H., 2nd Necrotizing fasciitis of perineum. Surgery. 1982 Jan;91(1):49–51. [PubMed] [Google Scholar]
- Slater D. N., Smith G. T., Mundy K. Diabetes mellitus with ketoacidosis presenting as Fournier's gangrene. J R Soc Med. 1982 Jul;75(7):530–532. doi: 10.1177/014107688207500708. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sleigh J. W., Linter S. P. Hazards of hydrogen peroxide. Br Med J (Clin Res Ed) 1985 Dec 14;291(6510):1706–1706. doi: 10.1136/bmj.291.6510.1706. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Spirnak J. P., Resnick M. I., Hampel N., Persky L. Fournier's gangrene: report of 20 patients. J Urol. 1984 Feb;131(2):289–291. doi: 10.1016/s0022-5347(17)50351-1. [DOI] [PubMed] [Google Scholar]
- Stone H. H., Martin J. D., Jr Synergistic necrotizing cellulitis. Ann Surg. 1972 May;175(5):702–711. doi: 10.1097/00000658-197205000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- WILSON B. Necrotizing fasciitis. Am Surg. 1952 Apr;18(4):416–431. [PubMed] [Google Scholar]