Editing Fournier's Gangrene (section)

== Relevant anatomy ==

* See Figure
* '''<span style="color:#ff0000">Superior to inguinal ligament</span>'''
** '''Layers (superficial to deep)'''
*** '''Skin'''
*** '''Camper’s fascia'''
**** Layer of fat-containing tissue of varying thickness and the superficial vessels to the skin that run through it.
*** '''<span style="color:#ff0000">Scarpa’s fascia</span>'''
**** '''<span style="color:#ff0000">Continuous with</span>'''
***** '''<span style="color:#ff0000">Colles’ fascia (superficial perineal fascia) in the perineum</span>'''
***** '''<span style="color:#ff0000">Dartos fascia in the penis</span>'''
***** '''<span style="color:#ff0000">Dartos fascia in the scrotum</span>'''
* '''Pelvis'''
** '''Colle’s fascia''' (see [[wikipedia:Fascia_of_Colles#/media/File:Gray403.png|Figure]])
*** Attached to the pubic arch and the base of the perineal membrane
**** Perineal membrane is also known as the inferior fascia of the urogenital diaphragm and, together with Colles’ fascia, defines the superficial perineal space
***** Superficial perineal space contains the membranous urethra, bulbar urethra, and bulbourethral glands. In addition, this space is adjacent to the anterior anal wall and ischiorectal fossae.
****** Infectious disease of the male urethra, bulbourethral glands, perineal structures, or rectum can drain into the superficial perineal space and can extend into the scrotum or into the anterior abdominal wall up to the level of the clavicles.
* '''<span style="color:#ff0000">Fournier's gangrene involves superficial and deep fascia (Camper's, Scarpa's/Dartos/Colle's) and skin</span>'''
** '''Often spares the deep muscular structures and, to variable degrees, the overlying skin.'''
*** '''<span style="color:#ff0000">Corpora, urethera, testes, and cord structures are usually not involved</span>'''
**** The contents of the scrotum, namely the testes, epididymides and cord structures, are invested by several fascial layers distinct from the Dartos fascia of the scrotal wall.
***** The most superficial layer of the testis and cord is the external spermatic fascia, which is continuous with the external oblique aponeurosis of the superficial inguinal ring.
***** The next deeper layer is the internal spermatic fascia, which is continuous with the transversalis fascia.
***** The Buck fascia covers the erectile bodies of the penis, the corpora cavernosa, and the anterior urethra. The Buck fascia fuses to the dense tunica albuginea of the corpora cavernosa, deep in the pelvis.
***** These fascial layers do not become involved with an infection of the superficial perineal space and can limit the depth of tissue destruction in a necrotizing infection of the genitalia.
** '''<span style="color:#ff0000">Infection travels along the facial planes</span>'''
*** Can extend posteriorly the Dartos fascia to involve the Colles' fascia, but are limited from the anal margin by the attachment of the Colles' fascia to the perineal body.
**** '''<span style="color:#ff0000">Clinical implication: infection limited posteriorly by Colles' fascia</span>'''
*** Can extend along the anterior abdominal wall through a potential space between the Scarpa’s fascia and the deep fascia of the anterior wall (external abdominal oblique).
**** Superiorly, Scarpa’s and Camper’s fasciae coalesce and attach to the clavicles
**** '''<span style="color:#ff0000">Clinical implication: infection limited superiorly by clavicles</span>'''