Fourniers Gangrene

Question 1

What is fourniers gangrene?

Answer 1

Form of necrotising fascilitis that affects the perineum - rare but a urological emergency

Question 2

What is necrotising fascitis?

Answer 2

Group of rapidly spreading necrosis of subcutaneous tissue and fascia.

Question 3

What can cause fourniers gangrene?

Answer 3

Mononmicrobial or polymicrobial infection - causative organism including Group A streptococcus, C.Perfringes and E.coli.

Question 4

What are the anatomic barriers to the spread of infection in the perineum?

Answer 4

Dartos fasica of the penis and scrotum.
Colles fascia of the perineum and Scarpa fascia of the anterior abdominal wall.
As a result testes and epididymis are commonly not affected by fascitis.

Question 5

What are the risk factors for fourniers gangrene?

Answer 5

DM
Excess alcohol intake 
Poor nutritional state 
Excess steroid use 
Haematological malignancies 
Recent trauma to region

Question 6

What are the clinical feature of fourniers gangrene?

Answer 6

Early stage - severe pain out of proportion to clinical signs or as pyrexia

Non-specific - until deterioration (‘not quite right for cellulitis’)

May have crepitus, skin necrosis and haemorrahgic bullae as condition progress with some sensory loss of overlying skin.

Rapidly deteriorate and septic and may enter septic shock

Question 7

What may be the differential diagnosis for fourniers gangrene?

Answer 7

Cellulitis

Epididymyo-orchitis

Testicular torsion

Question 8

What are th investigations that may be ordered for fourniers gangrene?

Answer 8

Routine bloods
Blood cultures - incuding HbA1c for underlying DM

But all suspected cases based on clincial diagnosis should be taken for surgical exploration

CT imaging may be ordered - fasical swelling and soft tissue gas

Question 9

What risk score may be used to diagnose necrotising fascitis on lab results alone?

Answer 9

Laboratory Risk Indicator for Necrotising Fascitis (LRINEC) - score ≥6

Not widely accepted

Question 10

What is the management of fourniers gangrene?

Answer 10

Urgent sugical debridement

Tissue removed should be sent for histology and culture(MC&S) and any pus for fluid culture too.

Broad spec antibiotics and then taliored according to results of MC&S. Pt shoul be placed on HDU and further surgical relooks and debridement may berequired until pt free of necrotic tissue.

Skin grafts - early involvement of plastic surgeons