Necrotizing perineal infections (Fournier's disease): old remedies for an old disease

Perineoscrotal gangrene (Fournier's disease, a specific type of necrotizing fasciitis) is a rare and potentially fatal clinical entity characterized by progressive spread of necrosis in the skin and subcutaneous tissues combined with severe systemic sepsis. We analyzed retrospectively seven patients with perineoscrotal gangrene, illustrating the various clinical presentations, problems in management, and specific approaches to therapy. On admission all patients were evaluated as being in critical condition, having severe systemic disease and rapidly advancing gangrene. After hemodynamic stability was achieved broad spectrum antibiotics were started, and aggressive surgical treatment initiated. In all the patients the infection originated from the anorectal area and proved to be polymicrobial in nature. Six patients survived and were able to be discharged from hospital there was one death on the fifth postoperative day due to pulmonary embolism. The crucial points in the management of this infection remains early diagnosis, wide and repeated surgical debridements, and appropriate antibiotic therapy.