[Gangrene of the external genitalia]

The term gangrene of the male external genital organs is applied to two different entities : Primary gangrene of the external genital organs (5% of cases), also called Fournier's disease, first described in 1883 : gangrene of the integument of the external genital organs in the absence of a local cause, according to an unknown mechanism and with inevitable progression towards a specific distribution of necrosis, regardless of treatment. "Secondary" gangrene of the external genital organs (95% of cases) related to a local, cutaneous, urogenital or gastrointestinal cause, whose course can be modified by early application of appropriate treatment. An early diagnosis is essential : in true Fournier's disease to avoid the systemic complications of this necrosis, and in secondary gangrene to limit the local extension and to prevent systemic complications. In view of the galloping course of the disease and in order to very rapidly reach the diagnosis, many authors recommend : local aspiration, biopsy or search for subcutaneous gas by ultrasound or radiology. Treatment consists of : Antibiotic therapy using two or three antibiotics to cover the usually mixed bacterial flora (Gram positive cocci, Gram negative bacilly and anaerobes). Surgical debridement as required, possibly repeated to excise necrotic zones, to drain collections and for irrigation of cavities. Hyperbaric oxygen therapy. Urinary diversion (cystostomy) or gastrointestinal diversion (colostomy) may be required when either of these two tracts are responsible for the infection, or when diversion facilitates management. Surgical reconstruction (grafts or flaps) as required. The mortality is high, of the order of 20% : < 10% in young patients with a good general condition who are correctly treated after an early diagnosis; > 50% in elderly patients with other concomitant diseases, when diagnosis and treatment are delayed.