Review Article Global Surgery Glob Surg, 2018 doi: 10.15761/GOS.1000178 Volume 4(1): 1-5 ISSN: 2396-7307 Fournier’s gangrene: A review of contemporary management priorities Mohammed Aldiwani 1 , Victor Palit 2 , Chandrashekhar Biyani 2 * and Sanjib Majumder 3 1 Imperial college NHS Trust, UK 2 St James’s University Hospital, UK 3 Pinderfields Hospital, UK Abstract Fournier’s gangrene was formally described in 1883 by Jean Alfred Fournier. It is a life-threatening condition characterised by necrotising polymicrobial infection of the perineal and genital region. Although relatively uncommon; prompt recognition and urgent debridement is key to control the infection and give the best chance of survival. Subsequent wound management ranges from healing by secondary intention for small areas, but most cases require reconstruction by plastic surgeons. Herein, we discuss a review of the contemporary information surrounding this condition. Introduction Fournier’s gangrene (FG) is a life-threatening necrotising fasciitis of the perineal and genital region. Although Jean Alfred Fournier has been credited with first describing the condition in 1883 [1]; the first report of scrotal gangrene originates from a case described by Baurienne in 1764 [2,3]. Baurienne described the first debridement aſter a man was injured by the horns of an ox. He required more than one debridement and eventually recovered with the skin defect healing by secondary intention. In 1883, Fournier described rapidly progressing gangrenous infection of the genital area of otherwise healthy young men with unknown cause. e term “Fournier’s gangrene” is therefore somewhat confusing. Although Fournier’s original description was idiopathic; more frequently, a cause can be identified [4]. is term now incorporates necrotising fasciitis of the genitalia of known aetiology in much older groups of patients with a more indolent onset [5]. e most common demographic is middle aged men between 50-60 years of age [6]. FG can occur in females although much less commonly; with a male to female ratio of 10:1 [7]. Background Anatomy FG is characterised by necrotising infection along the superficial perineal fascia (Colle’s fascia). is fascia runs continuously with the dartos fascia of the genitalia and superiorly in the abdomen where it is known as Scarpa’s fascia. Perineal infections can therefore extend towards these areas but will usually spare the deeper tissues including the testicles which have a separate direct blood supply from the aorta. Colle’s fascia attaches posteriorly to the perineal body and so infections arising from the urogenital structures do not usually reach the anus. In contrast, anorectal infections usually breach the sphincteric musculature before reaching Colle’s fascia and then spread anteriorly [8]. Due to the infective focus in the fascia layer, the skin appearances are oſten understated in comparison to the underlying tissue. *Correspondence to: Chandrashekhar Biyani, St James’s University Hospital, Leeds, UK, E-mail: shekharbiyani@hotmail.com Key words: fournier’s gangrene, necrotising fasciitis, urosepsis Received: April 07, 2018; Accepted: April 23, 2018; Published: April 28, 2018 Organisms Infection is polymicrobial and in most cases, a source can be identified from anorectal, genitourinary or skin commensal organisms. Bacterial cultures include a mixture of aerobes and anaerobes. Commonly implicated organisms include E. Coli; Proteus; Klebsiella; Bacteroides; Clostridium, Streptococci and Staphylococci. ese organisms work synergistically producing accumulating toxins and thus inflicting rapid and devastating tissue damage. Causes e causes of infection are most commonly dermatological, urological or colorectal. Entry can result from direct trauma from the skin, as well as iatrogenic operative complications from any operation in the perineal region. Foreign bodies have also been implicated whether caused by a clinician or the patient. Urinary tract causes include urinary tract stone disease, urethral catheterisation, and renal abscess. Colorectal causes are described as the most common foci of infection in many case series’ and include anorectal abscess, colorectal malignancy, inflammatory bowel disease and even intraabdominal sepsis from appendicitis or diverticulitits [5]. In women, anorectal causes are still the most common source however other female specific causes include genital abscess or post-operative complications [9]. When an obvious external source cannot be identified; it is advised to investigate for an abdominal source with cross sectional imaging such as Computed Tomography (CT). In some cases, no obvious cause is identified as per Fournier’s initial description. It is important to recognise that co- morbidity plays a significant causative role. Many patients who develop FG are afflicted with accompanying comorbidities including diabetes