FEATURE: MARA KOHLS, PA-C; CHRISTOPHER M. HOWELL, DSC, MSC, MPAS, PA-C, MBA, FAAPA
Fournier Gangrene: A Rare Flesh-Eating Soft Tissue Infection Prompt identification of Fournier gangrene is essential, as the condition can have numerous life-threatening complications.
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escribed first by Jean-Alfred Fournier in 1883 as an idiopathic condition, Fournier gangrene (FG) is now widely understood to be a fulminant necrotizing fasciitis of the genitals, perineum, and perianal regions.1-3 FG is a rare and potentially fatal form of necrotizing fasciitis requiring rapid recognition and early surgical intervention.1,2,4-8 Necrotizing soft tissue infections can progress rapidly and can affect any or all the layers of soft tissue from the dermis through the fascial and muscle compartments.8 Failing to promptly identify FG is regarded as one of the greatest impediments to management, as this process can possess an array of early nonspecific symptoms such as tachycardia, erythema, and focal tenderness.2,4,8 However, as the disease progresses, findings may include pain disproportionate to appearance, hemorrhagic bullae, tense edema, and crepitus in the perineum.8 Due in large part to the ambiguous nature of this spectrum of disease progression, a high index of suspicion is required for diagnosis and begins with knowledge of high-risk patient populations.8 Population
Early surgical intervention can reduce mortality associated with Fournier gangrene.
20 THE CLINICAL ADVISOR • JUNE 2019 • www.ClinicalAdvisor.com
FG most commonly affects patients with complex comorbidities, such as diabetes mellitus, chronic substance abuse (eg, alcohol, tobacco, and/or intravenous [IV] drug use), obesity, hypertension, or immunosuppression (Table 1).1,6,7,9,10 Although most often presenting in men in the