Editing Fournier's Gangrene (section)

== Management ==

* '''<span style="color:#ff0000">Urological emergency; requires urgent management</span>'''
** '''<span style="color:#ff0000">Essential interventions in stopping the rapidly progressing infectious process of Fournier's gangrene</span>'''
**# '''<span style="color:#ff0000">Early recognition of the diagnosis</span>'''
**# '''<span style="color:#ff0000">Aggressive surgical debridement</span>'''
**# '''<span style="color:#ff0000">Use of broad-spectrum antibiotics</span>'''
**#* '''<span style="color:#ff0000">Anti-microbial regimens include broad-spectrum antibiotics (β-lactam plus β-lactamase inhibitor) such as piperacillin-tazobactam</span>'''
** '''IV hydration is indicated in preparation for surgical debridement'''
** '''<span style="color:#ff0000">Immediate debridement of skin and involved dartos/scarpa/colle fasica is essential.'''
*** '''Extensive incision should be made through the skin and subcutaneous tissues, going beyond the areas of involvement until normal fascia is found.'''
**** '''Clinical implication: prepare with antiseptic solution widely at the time of surgery (i.e. up to clavicles, down thighs)'''
*** '''Necrotic fat and fascia should be excised, and the wound should be left open.'''
**** '''<span style="color:#ff0000">External, cremasteric, and internal spermatic fasciae are spared</span>'''
***** '''<span style="color:#ff0000">These layers are embryologically distinct from the skin and dartos layers and have their own blood and nerve supplies.</span>'''
*** '''<span style="color:#ff0000">Orchiectomy is almost never required</span>'''
**** '''<span style="color:#ff0000">Testes have their own blood supply independent of the compromised fascial and cutaneous circulation to the scrotum.</span>'''
*** A second procedure 24 to 48 hours later is indicated if there is any question about the adequacy of initial debridement.
* '''Adjunctive procedures''' (should be included in pre-surgical consent)
** '''Suprapubic diversion should be performed in cases in which urethral trauma or extravasation is suspected.'''
** '''Colostomy''' should be performed if there is colonic or rectal perforation.
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