NECROTIZING SOFT TISSUE INFECTION: FOURNIER GANGRENE

Dr. Murat Kalın

İstanbul Sultan Abdulhamid Han Training and Research Hospital, Department of General Surgery, İstanbul, Türkiye

ABSTRACT

Fournier’s gangrene (FG) is a rapidly progressing necrotizing soft tissue infection that affects the perineal, genital, and perianal regions, carrying a high risk of mortality. This polymicrobial infection is characterized by obliterative endarteritis and arteriolar thrombosis, leading to systemic sepsis and widespread tissue necrosis if left untreated. The often vague and non-specific early symptoms of FG can delay diagnosis, which is a significant factor contributing to the poor prognosis of the disease. Delayed diagnosis is directly related to delayed treatment, resulting in high mortality rates.

The etiology of FG involves a broad spectrum of pathogens, with infections typically originating from gen- itourinary, anorectal, or perineal skin sources. Most cases are caused by synergistic interactions between gram-positive and gram-negative aerobic and anaerobic bacteria, which rapidly spread to adjacent tissues and cause extensive tissue destruction. Immunocompromised individuals, patients with diabetes, and the elderly are at higher risk for developing the condition. Although FG is far more common in men than in women, clinical presentations in women tend to be more severe. Despite being rarer in women, diagnosis is often made at more advanced stages, contributing to poorer outcomes.

The primary treatment approach for FG includes prompt and aggressive surgical debridement, broad-spectrum antibiotic therapy, and intensive fluid resuscitation. Surgical intervention must be performed without delay, as any delay significantly increases mortality rates. Adjunctive therapies such as hyperbaric oxygen therapy (HBOT) and vacuum-assisted closure (VAC) have shown potential in improving patient outcomes, though more evidence is needed to confirm their long-term benefits. Prognosis is influenced by the extent of infection, the patient’s overall health, comorbidities, and the timing of surgical intervention. Clinical scoring systems, such as the Fournier’s Gangrene Severity Index (FGSI) and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), play a critical role in guiding diagnosis and treatment.

Keywords: Fournier gangrene; Perineum; Subcutaneous emphysema; Early diagnosis; Hyperbaric oxygenatio

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