title: [Life-threatening cellulitis, or Fournier's gangrene of the perineum].
abstract: The global mortality for Fournier's gangrene is one in five. In half the cases, the infection is polymicrobial with either anaerobes or gram negative bacilli. Factors which worsen prognosis include renal insufficiency, streptococcal infection, or need for hospital admission. Diagnosis must be prompt and treatment multidisciplinary involving the surgeon, intensivist, and infectious disease specialist; early and adequate surgical debridement must be accompanied by well-chosen antibiotics and hyperbaric oxygen therapy. Post-debridement therapy requires a long period of dressing changes and skin grafting to achieve final wound closure. This is an aggressive disease with a high mortality, but the depth and extent of invasive infection does not determine prognosis; the first priority is prompt and wide surgical excision/debridement of infected tissues to pre-empt the development of systemic sepsis; this should not be deferred while arranging transfer to a facility with a hyperbaric chamber.
authors.affiliation: Service de Chirurgie Viscérale, Hôpital du Val de Grâce--Paris. cadot.patrick@wanadoo.fr
authors.forename: P
authors.initials: P
authors.lastname: Cadot
authors.forename: I
authors.initials: I
authors.lastname: Rouquette
authors.forename: P
authors.initials: P
authors.lastname: Szym
authors.forename: J L
authors.initials: JL
authors.lastname: André
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D018934:Fournier Gangrene / Q000145:classification / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery / Q000628:therapy; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D010502:Perineum; D011182:Postoperative Care; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents
vernacular_title: Les cellulites graves, ou gangrène de Fournier du périnée.