Fournier's gangrene.

Fournier’s gangrene is a necrotizing process caused by synergistic bacterial infection of the superficial soft tissue of the external genitalia. Perirectal, periurethral, or superficial infection of the perineum or scrotum is the most common origin of the disease. Many but not all patients have identifiable risk factors such as diabetes. The superficial spread of disease in the fascial planes of the penis, scrotum, perineum, and anterior abdominal wall is predictable based on the blood supply and fascial anatomy. Rapid diagnosis, emergent aggressive surgical debridement, and supportive care including medical resuscitation and broad-spectrum antibiotics remain the keys to management of this urological emergency. After debridement, prolonged dressing care or vacuum-assisted therapy is necessary to prepare the wound bed for autografting or other skin coverage. This wound care often results in significant morbidity and the need for ongoing care after discharge. Despite optimal medical and surgical care, Fournier’s gangrene remains a potentially lethal disease, especially in patients of advanced age and those with extensive disease. Greater hospital experience with Fournier’s gangrene appears to decrease mortality supporting the role of further regionalization of care for this rare disease.