Fourniers Gangreen

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Fourniers Gangreen

• Dr MJ Engelbrecht
• Dept Urology
• University of Pretoria

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Definition

• Necrotizing faciitis in which the primary
  etiology remains a mystery
• It is however widely used to describe a
  necrotizing infection of the genitalia and
  perineum in either a male or female
• Reported mortality of up to 45

Alfred Fournier - 1883
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Clinical presentation

• Local signs and symptoms
• Pain and edema (100 of patients)
• Erythema
• Crepitus
• Necrosis of the underlying skin
• Purulent discharge
• Systemic
• Fever
• Septic shock
• Multi organ failure

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Clinical presentation
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Clinical presentation
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Clinical presentation
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Clinical presentation
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Pathophysiology

• Polimicrobial infection caused by colorectal,
  urogenital and dermatological flora.
• Infection begins locally with release of
  inflammatory mediators
• This leads to local edema and decreased oxygen
  tension
• Continued inflammation leads to small vessel
  thrombosis with local necrosis.
• Hypoxic tissue provides a environment for
  synergistic polymicrobial growth
• Infection spreads rapidly through subcutaneous
  tissue planes

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Pathophysiology

• Most common co-morbidities
• DM
• Alcoholism
• HIV (Immune compromised patients)

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Diagnostic studies

• CLINICAL DIAGNOSIS!!!
• AXR
• Subcutaneous gas
• Scrotal ultrasound
• Intrascrotal gas

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Anatomy

• Colles Fascia involved in most cases
• Continues up the anterior abdominal wall as
  Campers fascia and Scarpas fascia
• Continues as the dartos fascia on the penis
• Boundaries
• Fascia lata inferior and lateral
• Urogenital diaphragm posterior
• Buck fascia protects the corpora cavernosum
• Almost never testicular involvement
• If testicular involvement consider explorative
  laparotomy for intra abdominal sepsis

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Treatment

• Rescusitation
• Fluids
• Broad spectrum antibiotics
• SURGERY!!
• Early aggressive surgical debridement of
  devitalized tissue will improve survival

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Surgery
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Surgery
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Penile Reconstruction

• Potent
• Primary closure
• Thick Split Thickness skin graft
• Full thickness skin graft
• Scrotal cutaneous penile flap
• Impotent
• Meshed Split thickness skin graft

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Scrotal reconstruction

• Primary closure
• Superficial testicular thigh pouches
• Poor cosmesis
• Decreased sperm production
• Pain with stretch
• Meshed STSG
• Fascio cutaneous and Muscle flaps

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Reconstruction