Fournier's gangrene: the need for early recognition and radical surgical débridement

Fournier's gangrene, a specific form of necrotizing fasciitis, predominantly affects the male genitals, perineum and perianal region. Most frequently Fournier's gangrene is caused by the synergistic action of aerobic and anaerobic microorganisms and leads to early septicaemia with a high mortality. The case histories of three patients with Fournier's gangrene are presented to illustrate the importance of early recognition and radical surgical débridement as essential objectives for therapeutic success. In the first patient, who died of Fournier's gangrene after a vasectomy, appropriate therapy was significantly delayed due to late recognition of the condition. The second patient presented with a rapidly progressive fasciitis secondary to a perianal abscess; immediate excision of all necrotic tissue was successfully performed. The third patient developed gangrene from an urogenital infectious focus, which was primarily treated by insufficient incisional and drainage therapy. Only after radical débridement his general condition rapidly improved.