[Fournier's gangrene as special form of necrotizing fasciitis].Chirurg 2020C
Fournier's gangrene is a special form of necrotizing soft tissue infection (NSTI) and can affect the genital, perineal and perianal regions. Although the disease is named after Fournier, it was first documented by Baurienne in 1764. He described it as idiopathic rapidly progressive gangrene in young otherwise healthy men. Nowadays, the disease is more likely to affect older patients, especially those with pre-existing diseases (e.g. diabetes mellitus and peripheral arterial occlusive disease). Although men are still predominantly affected by Fournier's gangrene, by definition it can also affect women. In most cases it is caused by polymicrobial infections with Enterobacteriaceae. The less common monomicrobial infections are frequently caused by beta hemolyzing Streptococci and then frequently in connection with toxic shock syndrome. Early and aggressive surgical and antimicrobial treatment is crucial to reduce mortality and morbidity. The indications for surgical exploration must be generously considered. The calculated antimicrobial treatment should be carried out as soon as possible, intravenously and in a sufficiently high dosage to catch the expected pathogen. In the era of overspecialization, the treatment of Fournier's gangrene remains a competence that must be comprehensively mastered by clinically active surgeons and urologists. Little has changed with respect to the diagnostic and treatment algorithms in recent years; nevertheless, based on the abovenamed aspects it would appear to be meaningful to present the current aspects and treatment of the disease.