Fournier's Gangrene: Difference between revisions
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== Management == | == Management == | ||
* '''Urological emergency; requires urgent management''' | * '''<span style="color:#ff0000">Urological emergency; requires urgent management</span>''' | ||
** '''Essential interventions in stopping the rapidly progressing infectious process of Fournier's gangrene''' | ** '''<span style="color:#ff0000">Essential interventions in stopping the rapidly progressing infectious process of Fournier's gangrene</span>''' | ||
**# '''Early recognition of the diagnosis''' | **# '''<span style="color:#ff0000">Early recognition of the diagnosis</span>''' | ||
**# '''Aggressive surgical debridement''' | **# '''<span style="color:#ff0000">Aggressive surgical debridement</span>''' | ||
**# '''Use of broad-spectrum antibiotics''' | **# '''<span style="color:#ff0000">Use of broad-spectrum antibiotics</span>''' | ||
**#* '''Anti-microbial regimens include broad-spectrum antibiotics (β-lactam plus β-lactamase inhibitor) such as piperacillin-tazobactam''' | **#* '''<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''' | ** '''IV hydration is indicated in preparation for surgical debridement''' | ||
** '''Immediate debridement of skin and involved dartos/scarpa/colle fasica is essential.''' | ** '''<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.''' | *** '''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)''' | **** '''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.''' | *** '''Necrotic fat and fascia should be excised, and the wound should be left open.''' | ||
**** '''External, cremasteric, and internal spermatic fasciae are spared''' | **** '''<span style="color:#ff0000">External, cremasteric, and internal spermatic fasciae are spared</span>''' | ||
***** '''These layers are embryologically distinct from the skin and dartos layers and have their own blood and nerve supplies.''' | ***** '''<span style="color:#ff0000">These layers are embryologically distinct from the skin and dartos layers and have their own blood and nerve supplies.</span>''' | ||
*** '''Orchiectomy is almost never required''' | *** '''<span style="color:#ff0000">Orchiectomy is almost never required</span>''' | ||
**** '''Testes have their own blood supply independent of the compromised fascial and cutaneous circulation to the scrotum''' | **** '''<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. | *** 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) | * '''Adjunctive procedures''' (should be included in pre-surgical consent) | ||