Fournier's gangrene.
BACKGROUND
Fournier's gangrene (FG) represents a necrotizing infection of the skin and subcutaneous soft tissue of the external genitalia and perineum. It arises as a result of propagation of anorectal, urogenital and skin infections. The principles of treatment include improving general condition of a patient, debridement of wound, excision of necrotic tissue, combined antibiotic therapy, hyperbaric oxygen therapy and reconstructive procedures. It is a rare but very serious condition which regardless to aggressive treatment can lead to a lethal outcome in up to 20-30% of patients.


METHODS
Since the year 2000 we have treated six patients with FG. We presented the course and positive treatment outcome in a 65-year-old male patient with numerous comorbid conditions, nonregulated insulin-dependent diabetes, hypertension, previous myocardial infarction, chronic viral hepatitis and thrombocytopenia, rehabilitation was complicated with heart failure, atrial fibrillation and pulmonary thromboembolism. The treatment consisted of two extensive debridement of the wound with removing necrotic tissue, drainage, consolidation of state of health, correction of his blood sugar levels and thrombocytopenia, antimycotic and combination of three antibiotics and hyperbaric oxygen therapy. In two delayed surgical procedures reconstruction of a large defect of the urethra was performed.


CONCLUSIONS
A patient with numerous and serious comorbid conditions with FG could recover as a result of teamwork of urologists, infective medicine specialists, cardiologists, endocrinologist, vascular and plastic surgeons.
Milović
Novak
N
Military Medical Academy, Urology Clinic, Belgrade, Serbia.
Bancević
Vladimir
V
Campara
Zoran
Z
Kosević
Branko
B
Zoranović
Uros
U
D000368:Aged; D018934:Fournier Gangrene / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male