1. Dr MJ Engelbrecht Dept Urology University of Pretoria
Fourniers Gangreen
Dr MJ Engelbrecht
Dept Urology
University of Pretoria

2. Definition
Necrotizing faciitis in which the primary etiology remains a mystery
It is however widely used to describe a necrotizing infection of the genitalia and perineum in either a male or female
Reported mortality of up to 45%
Alfred Fournier

3. Clinical presentation
Local signs and symptoms
Pain and edema (100% of patients)
Erythema
Crepitus
Necrosis of the underlying skin
Purulent discharge
Systemic
Fever
Septic shock
Multi organ failure

4. Clinical presentation

5. Clinical presentation

6. Clinical presentation

7. Clinical presentation

8. Pathophysiology
Polimicrobial infection caused by colorectal, urogenital and dermatological flora.
Infection begins locally with release of inflammatory mediators
This leads to local edema and decreased oxygen tension
Continued inflammation leads to small vessel thrombosis with local necrosis.
Hypoxic tissue provides a environment for synergistic polymicrobial growth
Infection spreads rapidly through subcutaneous tissue planes

9. Pathophysiology Most common co-morbidities DM Alcoholism
HIV (Immune compromised patients)

10. Diagnostic studies CLINICAL DIAGNOSIS!!! AXR Scrotal ultrasound
Subcutaneous gas
Scrotal ultrasound
Intrascrotal gas

11. Anatomy Colles Fascia involved in most cases
Continues up the anterior abdominal wall as Camper’s fascia and Scarpa’s fascia
Continues as the dartos fascia on the penis
Boundaries
Fascia lata – inferior and lateral
Urogenital diaphragm – posterior
Buck’ fascia – protects the corpora cavernosum
Almost never testicular involvement
If testicular involvement consider explorative laparotomy for intra abdominal sepsis

12. Treatment Rescusitation SURGERY!! Fluids Broad spectrum antibiotics
Early aggressive surgical debridement of devitalized tissue will improve survival

13. Surgery

14. Surgery

15. Penile Reconstruction
Potent
Primary closure
Thick Split Thickness skin graft
Full thickness skin graft
Scrotal cutaneous penile flap
Impotent
Meshed Split thickness skin graft

16. Scrotal reconstruction
Primary closure
Superficial testicular thigh pouches
Poor cosmesis
Decreased sperm production
Pain with stretch
Meshed STSG
Fascio cutaneous and Muscle flaps

17. Reconstruction