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Background: Fournier's Gangrene is a severe surgical infectious disease, and various risk factors can increase its mortality rate. The purpose of this study is to retrospectively analyze the clinical characteristics and laboratory data of Fournier's Gangrene patients, followed by an analysis of mortality-related risk factors. This study has no secondary objectives., Methods: This study included 46 hospitalized patients diagnosed with Fournier's Gangrene at Suzhou Traditional Chinese Medicine Hospital from December 2013 to March 2024. Clinical data for all patients were extracted from the electronic medical records system. The collected data included gender, age, duration of illness, length of hospital stay, sites of infection involvement, comorbidities, white blood cell count, hematocrit, albumin, blood glucose, creatinine, serum sodium, serum potassium upon admission, microbial culture results, and patient outcomes (survival/death). The Simplified Fournier Gangrene Severe Index (SFGSI) was used to score all patients. Patients were categorized into survival and death groups based on clinical outcomes. Differences between categorical variables were compared using the χ² test or Fisher's exact test. Differences between numerical variables were compared using Student's t-test or the Mann-Whitney U test. Binary logistic regression was employed to analyze the risk factors for mortality in Fournier's Gangrene., Results: Among the 46 Fournier's Gangrene patients, 39 were male (84.8%) and 7 were female (15.2%). The age ranged from 17 to 86 years, with a median age of 61 years. Fourteen cases (30.4%) were confined to the perianal area, 26 cases (56.5%) had fascial necrosis involving the perianal, perineal, and genital regions, while 6 cases (13.0%) extended to the abdominal wall. At a 3-month postoperative follow-up, 43 patients (93.5%) survived, while 3 patients (6.5%) died shortly after admission due to severe illness. Based on the outcome, patients were divided into survival and death groups with 43 and 3 cases, respectively. Significant differences were observed between the two groups in terms of age (P<0.05), extension to the abdominal wall (P<0.01), hematocrit (P<0.01), albumin (P<0.01), SFGSI (P<0.01), and SFGSI>2 (P<0.01). Binary logistic regression analysis indicated that decreased hematocrit was an independent risk factor for mortality in Fournier's Gangrene patients., Conclusion: This study provides a detailed analysis of the clinical characteristics and risk factors for mortality in Fournier's Gangrene patients. The primary outcome of this study is that a decreased hematocrit is an independent risk factor for predicting mortality in FG patients. These findings offer valuable prognostic insights for clinicians, underscoring the importance of early identification and correction of reduced hematocrit to improve patient outcomes and survival rates., (© 2024. The Author(s).)

Introduction: Compare scoring systems using Fournier gangrene severity index (FGSI), Uludag Fournier gangrene severity index (UFGSI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and neutrophil-lymphocyte ratio (NLR) to predict the outcome of patients with Fournier gangrene., Materials and Methods: This is a retrospective cohort study that includes FG patients from 2012 to 2021. NLR, FGSI, UFGSI, and LRINEC values were calculated and analyzed. Each scoring system was analyzed using a receiver-operating curve (ROC) analysis to determine its sensitivity, specificity, and area under the curve (AUC). Statistical analysis was performed using SPSS version 25., Results: A total of 158 patients were included in this study. Regarding the mortality outcome, FGSI comprised the highest value of AUC with 80.9, with a sensitivity of 91.7% and specificity of 68.5%. LRINEC comprised the AUC value of 61.1, with 79.2% sensitivity and 64.2% specificity. NLR comprised an AUC value of 63.7, 91.7% of sensitivity, and 98.1% of specificity. In terms of length of stay, LRINEC and NLR were associated as significant predictor., Conclusion: FGSI, UFGSI, and NLR are significant predictors associated with mortality in patients with Fournier gangrene. FGSI and UFGSI comprised the highest sensitivity and specificity value in predicting mortality prognosis. Moreover, this study highlighted the role of NLR and LRINEC as significant predictors for the length of hospitalization. This study shows that FGSI is still a reliable scoring system for predicting mortality in patients with Fournier Gangrene., Level of Evidence: II., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: To predict testicular involvement in patients diagnosed with Fournier's gangrene (FG) using the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and the site other than lower limb (SIARI) score., Methods: The medical records of 51 patients operated for FG in our clinic between December 2012 and April 2022 were evaluated retrospectively in this study. Patients' demographics, and laboratory test results were compared with the testisticular involvement status. Patients with testisticular involvement (n = 10) were compared with patients without testicular involvement (n = 41). The SIARI score at initial admission was analysed using logistic regression analyses for its performance in predicting testicular involvement with FG. Receiver operating characteristics (ROC) curves and the area under the receiver operating characteristic curve (AUROC) were used to evaluate its discriminating ability., Results: The SIARI score had modest performance for diagnosing testicular involvement in FG patients, with ROC analysis showing an AUROC value of 0.83 (p < 0.001). With a SIARI cut-off score of ≥ 3, the sensitivity was 90% and the specificity was 68%. For a SIARI cut-off score of ≥ 5, the sensitivity was 40% and the specificity was 97%., Conclusions: The ability of the SIARI score to discriminate FG with testicular involvement is modest. The SIARI score should be employed cautiously as a routine diagnostic tool for the prediction of testicular involvement in FG at the initial admission. More research is needed to develop a better understanding of the relationship between the SIARI score and testicular involvement in FG., (© 2024. The Author(s).)

Introduction: Acute myelomonocytic leukemia is a type of acute myeloid leukemia with monocytic expansion. Both the disease and its treatment can be immunocompromising. Immunocompromised patients are more susceptible to infections, such as Fournier's gangrene, a rare necrotizing infection of the groin., Case Presentation: A 56-year-old male presented to the emergency department with abdominal pain, leukocytosis, and perineal ecchymosis. Overnight, his perineal discoloration and tenderness worsened. He underwent irrigation and debridement for Fournier's gangrene and received broad-spectrum antimicrobial therapy. Subsequent workup revealed acute myeloid leukemia with leukemia cutis and central nervous system involvement, necessitating chemotherapy initiation prior to complete wound healing., Discussion/conclusions: This case highlights the challenges in the diagnosis and management of acute leukemia in the setting of a concomitant life-threatening soft tissue infection, as both the hematologic disease and treatment thereof can exacerbate infectious complications., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Objectives: To examine the simplified Fournier Gangrene Severe Index Score (SFGSI) and the number of species in culture findings for predicting death in Fournier Gangrene (FG) patients in terms of their predictive power., Methods: From January 2017 to July 2022, the medical records of individuals undergoing emergency surgery for FG were obtained. A total of 80 patients were examined for clinical data such as age, gender, laboratory parameters, etiology, isolated bacteria, and mortality rate., Results: We identified a statistically significant mean difference between SFGSI ( p <0.0001) and quickSOFA (qSOFA) scores ( p =0.002) in determining the survival rate of FG patients. The sensitivity and specificity of the SFGSI score in predicting mortality were 90.1% and 88.3% respectively, whereas the sensitivity and specificity of the qSOFA score were 88.2% and 86.2%. E. Coli comprised 56.2% of the bacteria, followed by S. Haemolyticus , S. Aureus , P. Aeruginosa , and K. Pneumoniae . On the basis of bacterial culture results, P. Aeruginosa had the highest fatality rate (100%) followed by S. Aureus (75%), S. Haemolyticus (30%), and E. Coli (20%), in that order., Conclusion: The survival rate of FG patients can be predicted using the sensitivity and specificity of the SFGSI and qSOFA scores together. P. Aeruginosa- infected patients have the greatest mortality rate (100%) compared to the other groups., (Copyright: © Saudi Medical Journal.)

Fournier's gangrene is a rare, rapidly progressive, fulminant form of infective necrotising fasciitis of the genital, perianal and perineal regions. We present a case of Fournier's gangrene of the penis complicating acute genital ulceration and recurrent paraphimosis that was secondary to contemporaneous COVID-19 and Mpox infection in an otherwise healthy 41-year-old man. It is important for clinicians to be aware of Fournier's gangrene, as early detection remains the cornerstone of effective tissue and indeed life conserving management., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Declaration of Competing Interest All authors must disclose any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding.

Introduction: Fournier's gangrene (FG) is a necrotizing fasciitis affecting the perineum and urogenital tissue. The mortality rate is high although early detection and aggressive debridement can reduce mortality by up to 16%. The prevalence of sequelae is very high and a colostomy is often necessary to control the perineal wound., Material and Methods: A retrospective study was carried out to recruit all patients operated on by the General Surgery and Urology Departments with a diagnosis of GF at the University Hospital over 22 years. Mortality, the Fournier gangrene severity index (FGSI), and fecal diversion (either surgical (colostomy) or straight (Flexi-seal)) are collected., Results: A total of 149 patients met the inclusion criteria. FG's most frequent cause was a perianal abscess (107 patients-72%). Eighteen patients (12%) died of a specific cause of FG. Age (p = 0.014) and patients with an oncological history (p = 0.038) both were the only mortality risk factors for mortality according to logistic regression. Fifty patients required some form of fecal diversion in the postoperative period (32 colostomies and 18 Flexi-seal). Neither the use of postoperative fecal diversion (surgical or Flexi-seal) nor the timing of its use had any effect on postoperative mortality., Conclusions: One in eight patients died in the immediate postoperative period secondary to FG. Despite improved outcomes, 22% required a colostomy during admission. However, neither the performance of a colostomy nor the timing was associated with decreased FG-associated mortality. Non-invasive methods should be used first and surgical bowel diversion should be postponed as long as possible., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Fournier's gangrene (FG) is a rapidly progressing and life-threatening necrotizing fasciitis of the genital and perineal regions. To estimate the mortality rate associated with FG, Laor et al. developed the FG severity index (FGSI), an index with proven prognostic significance. On the other hand, the C-reactive protein (CRP)/albumin (CAR) ratio is a proven objective marker of inflam-matory response. In light of the foregoing, the objective of this study is to assess the prognostic value of the CAR ratio in predicting mortality in patients with FG in comparison with FGSI., Methods: This retrospective study consisted of 58 patients who were operated on for FG between 2019 and 2022. Research data were obtained from electronic and paper patient files, surgery notes, clinical follow-up forms, anamnesis, intensive care forms, and laboratory test results obtained from the hospital automation system. The clinical course of each patient was reviewed based on these records. The relationships between patients' CAR ratios and their demographic and clinical characteristics, including age, gender, and comorbidities, whether ostomy was performed, length of hospital stay, growth in wound culture, isolated bacterial species, FGSI scores, and laboratory test results (hemoglobin, sodium, potassium, bicarbonate, glucose, blood urea nitrogen (BUN), creatinine, albumin, and CRP levels, white blood cell counts, hematocrit values, glucose-to-potassium, neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-CRP ratios) and the prognostic power of CAR ratio in predicting the mortality associated with FG were investigated., Results: The mean age of the study group, 45 male and 13 female, was 57 (min. 17, max. 85) years. The most common predisposing factor was diabetes mellitus (DM), which was present in 32 (55.1%) patients. The most common symptoms at admission were erythema (89.6%), swelling/hardening (82.7%), pain (41.3%), fever (31%), and purulent discharge (37.9%). Of the 58 patients included in the study, six had died. The most common comorbidity, second to DM (55.1%), was cardiovascular disease (39.6%). The median ages of patients who had died and survived were 60 (min. 56, max. 85) and 56 (min. 18, max. 80) years, respectively. CAR ratio effectively differentiated FG patients who had survived from those who had died (area under the curve [AUC]: 0.907 [0.824-0.984]). The CAR ratio cutoff value of 2.8 effectively differentiated FG patients and FSGI scores who had survived from those who had died (AUC: 0.904 [0.823-0.992])., Conclusion: The study findings demonstrated that the CAR ratio might serve as an effective biomarker in predicting the mortal-ity associated with FG.

The observation presented is that of cellulitis of the external genitalia (Fournier's gangrene) in an elderly diabetic male hospitalized in Kati in Mali. The speed of progression and severity of this syndrome are detailed., (Copyright © 2023 SFMTSI.)

Purpose: To compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG)., Methods: A comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia's largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems., Results: Ten scoring systems were found, i.e., Fournier's Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860-0.950), SOFA (AUROC 0.830, 95% CI 0.815-0.921), and NFS (AUROC 0.823, 95% CI 0.739-0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91., Conclusion: This study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV., (© 2023. The Author(s).)

Background: Fournier's gangrene (FG) is a destructive necrotizing infection with a generally poor prognosis. This study aims to share our experience in handling FG patients in a resource-limited setting and identify prognostic factors for FG mortality., Methods: A retrospective study of thirty-six patients diagnosed with FG and treated at our teaching hospital between Jun 2010 to Oct 2022 was conducted. Laboratory and nonlaboratory data and patients' outcomes were gathered. A univariate analysis was computed for identifying prognostic factors for FG mortality., Result: The main age was 68.30 ± 5.61years and most (69.4%) were older than 65 years. The overall survival was 63.9% and the mortality rate was 36.1%. Univariate analysis showed that advanced age (p = 0.02), delayed in hospital presentation (p = 0.024), involvement of larger area (p = 0.001), a history of diabetes mellitus (p < 0.006), end-stage renal disease (p = 0.018), heart failure (p = 0.005), cerebrovascular accident (p = 0.003), liver cirrhosis (p = 0.001), presence of multiple comorbidities (p = 0.001), septic conditions at admission (p = 0.048), need for mechanical ventilation (p = 0.001), hypoalbuminemia (p < 0.001), and elevated blood urea nitrogen (p = 0.002) were found to be risk factors for mortality in patients with FG., Conclusions: Fournier's gangrene is a fulminant condition with a high mortality rate, especially in resource-limited settings. In this study, the mortality rate was 36.1%. Advanced age, delayed in hospital presentation, involvement of larger area, a history of diabetes mellitus, end-stage renal disease, heart failure, cerebrovascular accident, liver cirrhosis, presence of multiple comorbidities, septic conditions at admission, need for mechanical ventilation, hypoalbuminemia, and elevated blood urea nitrogen were associated with FG mortality.

Introduction: Fournier's gangrene (FG) is a rapidly progressive necrotizing infection that affects the perineal and abdominal regions and is known for its high mortality rate. This study aims to present the practical experience of managing FG patients and identify factors that may affect their clinical outcomes., Materials and Methods: A retrospective study was conducted from April 2009 to December 2020 at General Military Hospital in Sana'a, Yemen including 26 patients who were diagnosed with FG and treated on. Data on demographic characteristics, time to admission, surgical intervention, and treatment outcomes were collected. Univariate analysis was performed to determine factors that affect patient outcomes., Result: The mean age of the patients was 65.77 ± 5.04 years, and 65.4% of them were over the age of 65. Most patients (57.7%) presented after five days of experiencing symptoms, and 65.4% were in septic conditions. Of the patients, 17 (65.4%) survived, and the total mortality rate was 34.6%. Univariate analysis showed that delayed presentation (p = 0.001), a history of diabetes mellitus (p < 0.001), end-stage renal disease (p < 0.001), heart failure (p < 0.001), cerebrovascular accident (p = 0.032), liver cirrhosis (p < 001), presence of multiple comorbidities (p < 001), involvement of lager area (p < 001), septic conditions (p = 0.009), advanced age (p = 0.018), and intensive care unit admission (p = 0.002) were found to be risk factors for mortality in patients with FG., Conclusions: FG is a potentially life-threatening medical condition, even with aggressive and specialized treatment. Our study revealed a mortality rate of 34.6%. Factors such as older age, the presence of multiple comorbidities, septic conditions, the abdominal spread of the disease, intensive care unit admission, and delayed presentation contribute to higher mortality rates.

Study Objective: We describe the common presenting signs and symptoms, treatment modalities, and outcomes of acutely presenting scrotal pyoceles., Methods: We conducted a retrospective chart review of all adult patients treated for ultrasound-confirmed scrotal pyoceles between 2010 and 2020 at two sites within the [redacted]. Vitals at presentation, microbiology, and inpatient courses including antibiotic treatment and surgical procedures were collected., Results: A total of 360 scrotal ultrasounds were reviewed identifying 15 patients with pyoceles, 11 patients presenting to the emergency department and 4 hospitalized patients. The most common chief complaint was testicular pain (67%). Only seven patients (47%) met SIRS criteria upon presentation. All patients were initially treated with broad-spectrum antibiotics and observation; 11 (73%) responded to this management alone, while four patients (27%) required surgical drainage due to persistent infection. No patients contracted Fournier's gangrene., Conclusion: This study reports the largest published database of scrotal pyoceles to date and describes our clinical approach to management. While pyoceles have traditionally been treated aggressively with surgical drainage, this case series suggests that most patients improve with broad-spectrum antibiotic treatment and observation alone, requiring surgical drainage if infection persists. Future investigations including multi-institutional data will be necessary to validate our institution's approach., Competing Interests: Declaration of Competing Interest There are no conflicts of interest to report., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: Fournier's gangrene is a necrotizing infection of the external genitalia, perineal or perianal regions and is mainly seen in males. Its main risk factors include diabetes, chronic alcoholism, HIV and other immune-compromised states. Fournier's gangrene has an aggressive course associated with a mortality rate of 20%-30%, making early diagnosis and management very important. The Fournier Gangrene Severity Index (FGSI) has been traditionally used to predict the severity and prognosis. More recently, simplified FGSI (sFGSI) has been proposed and is helpful. However, timely diagnosis, supportive medical management and complete surgical debridement are still the cornerstones of treatment. These must be complemented with early and timely re-look debridements and appropriate reconstruction to cover soft tissue defects. This literature review aims to look at recent relevant research regards risk factors and prognostic features of Fournier's gangrene., Methods: A search was conducted on Google Scholar and PubMed databases for all articles related to Fournier's Gangrene. These included clinical reviews, case reports, case series and retrospective studies. Reports or studies which were not published in English were not reviewed. Various reconstructive techniques to cover the defects have also been revisited., Results: Broad-spectrum antibiotics and urgent surgical debridement are the core management principles of Fournier's gangrene. Repeat debridement after 24 h is also recommended. Adjunctive therapies such as hyperbaric oxygen and vacuum-assisted closure are supported in most aspects of recent literature. Expectedly, there is a lack of randomised controlled studies in such emergency surgical conditions, which limits the widespread use of newer therapies to patients unresponsive to conventional management., Conclusion: Fournier's gangrene is a urological emergency with a high mortality rate. The aggressive nature of the infection necessitates early recognition and immediate surgical intervention. Negative pressure dressing and occasional hyperbaric oxygen as adjuncts should be used more routinely, especially if there is a delayed response to conventional treatment or in severe infections.

Introduction: External genitalia gangrene is a well-known uncommon disease; however, mortality remains important. Recent literature focuses on early management. The object of this study was to assess quality of life and disease-specific function, in the medium- and long-term., Method: We evaluated retrospectively adult inpatients with external genitalia gangrene who had a surgical debridement between 2010 and 2020 at CHU de Poitiers. Preoperatory FGSI Score was calculated for patients included. In a second phase, surviving patients at 2020 who had agreed to take part in the follow-up were assessed by clinical examination, and asked to complete Short-Form 36 test and two additional disease-specific questionnaire (USP, IIEF5)., Results: The patients consisted of 33 men. Mean age was 61.18. Eleven patients (33%) died primarily from external genitalia gangrene. Median FGSI score was 6 (1-13). We were able to reach 11 patients (33%) for secondary clinical revaluation. Time before revaluation was 3months to 8years. All parts of SF-36 were significantly low. Mean USP score was 1.27±2.68/4.54±4.43/0.72±1.84. Nine patients (81%) suffered erectile dysfunction without any sexual intercourse possible., Conclusion: Patients with external genitalia gangrene experience severe deterioration of their quality of life. Multidisciplinary healthcare process should systematically be carried out, as so as early screening of vulnerability risks factors, to improve functional outcomes and quality of life., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background : Although rare, Fournier's gangrene is a major urological emergency. We aimed to learn more about the pathogenesis of Fournier's gangrene and assess the antibiotic resistance patterns in individuals with this disease. Methods : We retrospectively evaluated the patients diagnosed with and treated for Fournier's gangrene in a Neamt county hospital and "CI Parhon" Clinical Hospital in Iasi, Romania between 1 January 2016 and 1 June 2022. Results : We included a total of 40 patients, all males; of these, 12.5% died. In our study, in the patients that died, the adverse prognostic factors were a higher body temperature (38.12 ± 0.68 vs. 38.94 ± 0.85 °C; p = 0.009), an elevated WBC (17.4 ± 5.46 vs. 25.23 ± 7.48; p = 0.003), obesity (14.28% vs. 60%; p = 0.04), and a significantly higher FGSI (4.17 ± 2.80 vs. 9.4 ± 3.2; p = 0.0002) as well as MAR index (0.37 ± 0.29 vs. 0.59 ± 0.24; p = 0.036). These patients were more likely to have liver affections than those in the group who survived, but the difference was not significant. The most frequently identified microorganism in the tissue secretions culture was E. coli (40%), followed by Klebsiella pneumoniae (30%) and Enterococcus (10%). The highest MAR index was encountered in Acinetobacter (1), in a patient that did not survive, followed by Pseudomonas (0.85) and Proteus (0.75). Conclusions : Fournier's gangrene remains a fatal condition, a highly resistant causative microorganism that is not always correlated with a poor prognosis.

Objective: To find out the outcomes of Fournier's gangrene (FG) patients using clinical data and prognostic biomarkers based on the current literature., Study Design: Descriptive study. Place and Duration of the Study: Department of General Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey, from January 2018, to January 2022., Methodology: Patients who were diagnosed with and treated for FG were included in the study. Patients younger than 18 years of age, those with missing hospital records and postoperative follow-up data, those with benign diseases related to the perianal or anal region, and those with other malignant diseases were excluded from the study. Patients' demographic, clinical, and laboratory data, including the calculated systemic immune-inflammation index (SII) and pan-immune-inflammation values (PIV) were obtained retrospectively from the medical records. Variables were analysed using SPSS statistics software, version 25.0. The value of p <0.05 was considered statistically significant., Results: A total of twenty-four patients, 14 (58.3%) males and 10 (41.7%) females, were included in this study. No statistically significant correlations were found between the calculated indices and patients' clinical outcomes. The length of intensive care unit stay was strongly and positively correlated with age (r = 0.672 and p <0.001), and the length of hospital stay was moderately and inversely correlated with preoperative albumin levels (r = -0.584 and p = 0.003)., Conclusion: SII and PIV had no statistically significant interactions with FG., Key Words: Fournier's gangrene, Systemic immune-inflammation index, Pan-immune-inflammation value, Colostomy, Albumin.

A male patient in his 80s presented with the classic signs of Fournier's gangrene. At his initial debridement, an unusual florid involvement of the right cord was noted requiring a right inguinal orchidectomy in addition to extensive debridement. Although he subsequently stabilised in the intensive care unit, his inflammatory markers were noted to uptrend again requiring a relook procedure which revealed evidence of progressive necrosis in the right inguinal region. After further debridement, a CT scan of the abdomen and pelvis revealed intra-abdominal extension of the disease process with a retroperitoneal collection adjacent to the caecum-a rare complication of Fournier's gangrene. This required open surgical drainage for adequate disease control. He subsequently underwent split skin grafting prior to discharge to a rehabilitation facility., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Fournier's Gangrene (FG) has still a mortality rate up to 45%. Several studies identified prognostic factors but there is a knowledge gap concerning procalcitonin (PCT) levels and mortality risk in FG. This study is aimed to assess the role of PCT as prognostic factor in FG., Materials and Methods: The medical records of 20 male FG patients admitted at the Department of Urology of "Cattinara" Hospital, University of Trieste between January 2019 and November 2020 were retrospectively reviewed. Clinical, demographic, microbiological data were collected. The Fournier's Gangrene Severity Index (FGSI) was calculated for each patient., Results: Thirteen (65%) of 20 patients survived. Median age was 58 years (IQR 51-88), 15 patients (75%) had a Charlson Comorbidity Index (CCI) score ⩾2, 1 (5%) equal to 0, 4 to 1 (20%). Median FGSI score was 6 (IQR 2-12) and median PCT 0.8 ng/ml (IQR 0.04-2.12). At multivariate analysis PCT levels >0.05 ng/ml were associated with an increased overall mortality risk (OR 2.14, CI 1.25-4.27, p  = 0.002). CCI score ⩾2 (OR 1.51, CI 1.01-2.59, p  = 0.04), Streptococcical etiology (OR 3.41, CI 2.49-4.61, p  = 0.002) and FGSI score >9 (OR 1.41, CI 1.19-2.21, p  = 0.004) were associated with unfavorable outcome., Conclusion: PCT might be a prognostic factor in FG. CCI and FGSI are useful tools in mortality risk stratification. Streptococcical etiology is associated with unfavorable outcome. Further larger clinical trials are pending.

Competing Interests: T. Urbina déclare n’avoir aucun lien d’intérêts. B. Chousterman n’a pas fourni de déclaration de liens d’intérêts.

Cellulitis and abscess are common skin infections in military populations. Although complications of necrotizing soft tissue infections (NSTIs) such as Fournier Gangrene (FG) are rare, they are associated with significant morbidity and mortality. Laboratory and radiological studies may aid in the evaluation of NSTI; however, focus should remain on physical examination and prompt surgical consultation, as these infections can spread rapidly with significant increases in mortality with delayed management. We present the case of a 37-year-old male soldier with reported history of two distant left inguinal hernia repairs, complaining of increasing buttock pain despite outpatient antibiotic therapy for perineal cellulitis from his primary clinician. Despite normal vital signs and low risk from established NSTI calculator scores, examination revealed crepitus and severe tenderness extending from the buttock through the perineum and scrotum characteristic of FG. Preoperative computed tomography found additional spread of subcutaneous air from these areas into the lower abdomen, likely facilitated by the previously repaired left inguinal hernia. Surgical management necessitated debridement, multiple washouts, and ileostomy. Follow-up evaluations revealed previously undiagnosed Crohn's disease with fistula-in-ano as the inciting factor., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: The objective of the study was to investigate risk factors affecting mortality rates in patients with Fournier's gangrene (FG) and develop methods to increase the survival rate., Methods: We collected data of 73 patients treated for FG between February 2012 and June 2021 at Istanbul Professor Doctor Cemil Taşçıoğlu City Hospital General Surgery Clinic. The data of living patients (Group 1, n=56) and deceased patients (Group 2, n=17) were analyzed separately. Demographic data of patients were sex, age, infection rate, Uludag FG severity index (UFGSI) scores and FG severity index (FGSI) scores, urea serum levels, the source of infection, the presence of diabetes, obesity, the presence of diversion stoma, duration of vacuum-assisted closure treatment in days, hospitalization time in days, intensive care period in days, and isolated bacterial species., Results: The mortality rate was 23%. A significant difference in age and dissemination score of the infection was found between the two groups. According to UFGSI and FGSI scores, the scores of the two groups of patients were significantly higher. The UFGSI had 100% sensitivity and 68% sensitivity. FGSI had 82% sensitivity and 58% specificity. The cutoff values for UFGSI and FGSI were 8 and 6, respectively., Conclusion: Age and dissemination scores of diseases were important factors that cause mortality in patients with FG. However, an accurate scoring system is important in predicting patients to be treated in the intensive care unit (ICU). Patients with a UFGSI score above 8 face a higher risk of death and should be treated in the ICU.

Purpose: The purpose of this paper was to investigate patterns of health care utilization leading up to diagnosis of necrotizing soft tissue infections of the genitalia and to identify risk factors associated with potential diagnostic delay., Materials and Methods: IBM MarketScan Research Databases (2001-2020) were used to identify index cases of necrotizing soft tissue infections of the genitalia. We identified health care visits for symptomatically similar diagnoses (eg, penile swelling, cellulitis) that occurred prior to necrotizing soft tissue infections of the genitalia diagnosis. A change-point analysis identified the window before diagnosis where diagnostic opportunities first appeared. A simulation model estimated the likelihood symptomatically similar diagnosis visits represented a missed opportunity for earlier diagnosis. Patient and provider characteristics were evaluated for their associations with delay., Results: We identified 8,098 patients with necrotizing soft tissue infections of the genitalia, in which 4,032 (50%) had a symptomatically similar diagnosis visit in the 21-day diagnostic window, most commonly for "non-infectious urologic abnormalities" (eg, genital swelling; 64%): 46% received antibiotics; 16% saw a urologist. Models estimated that 5,096 of the symptomatically similar diagnosis visits (63%) represented diagnostic delay (mean duration 6.2 days; mean missed opportunities 1.8). Risk factors for delay included urinary tract infection history (OR 2.1) and morbid obesity (OR 1.6). Visits to more than 1 health care provider/location in a 24-hour period significantly decreased delay risk., Conclusions: Nearly 50% of insured patients who undergo debridement for, or die from, necrotizing soft tissue infections of the genitalia will present to a medical provider with a symptomatically similar diagnosis suggestive of early disease development. Many of these visits likely represent diagnostic delay. Efforts to minimize logistic and cognitive biases in this rare condition may lead to improved outcomes if they lead to earlier interventions.

Objectives: The delta neutrophil index represents the fraction of circulating immature granulocytes and is a marker of infection and sepsis. Our study aimed to evaluate the usefulness of the delta neutrophil index in predicting mortality in patients with Fournier's gangrene., Methods: We enrolled patients with Fournier's gangrene who were admitted to the Wonju Severance Christian Hospital (Wonju, Korea) between September 2010 and December 2021. We retrospectively analyzed the patients' characteristics, factors related to management, scoring systems such as the Fournier's Gangrene Severity Index, and laboratory data measured at initial presentation., Results: There were 58 (68.2%) survivors and 27 (31.8%) non-survivors. The initial levels of serum lactate, hemoglobin, delta neutrophil index, albumin, international normalized ratio, creatinine, Fournier's Gangrene Severity Index, Uludag Fournier's Gangrene Severity Index, and prognostic nutritional index differed between survivors and non-survivors. Age, international normalized ratio, and delta neutrophil index were independent predictors of mortality in Fournier's gangrene. In receiver operating characteristic curve analysis, delta neutrophil index on the day of admission was the best indicator of mortality (area under the curve, 0.804; 95% confidence interval [0.679-0.929]). The optimal cutoff for delta neutrophil index in predicting mortality was 11.25% (sensitivity, 74.1%; specificity, 91.4%). The initial delta neutrophil index was the best indicator of mortality (area under the curve, 0.804; 95% confidence interval 0.679-0.929)., Conclusion: The delta neutrophil index can be useful for predicting mortality in patients with Fournier's gangrene. A delta neutrophil index >11.25% at initial presentation is a reliable predictor of Fournier's gangrene., (© 2022 The Japanese Urological Association.)

The article is devoted to one of the rare forms of necrotizing fasciitis - Fourniers gangrene (FG). In chronological order, key aspects related to epidemiology, etiology, pathogenesis, classification, clinic, diagnosis and treatment are highlighted, according to extensive literature. It is postulated that according to modern scientific provisions, Fournier gangrene is a private clinical model of critical conditions in surgery, which is characterized by progressive purulent-necrotic lesion and putrefactive decay of soft tissue and fascial structures and is accompanied by phenomena of systemic endotoxicosis (sepsis) and high mortality, varying from 35 to 76-86%. It is declared that the trigger pathogenetic mechanism of the development of FG is disseminated thrombosis of the microcirculatory bed of the superficial fascia of the scrotum due to intravascular invasion of various strains of causative microbes. The methods of clinical, laboratory and instrumental diagnostics and methods of treatment are described, taking into account modern achievements of evidence-based medicine. Based on a multifactorial analysis of literature data and their own experience, the authors stated that the cornerstone that completely affects the outcome of treatment and prognosis of the disease is a multidisciplinary approach to solving diagnostic and therapeutic and tactical tasks with the participation of doctors of related specialties (surgeon, resuscitator, radiologist, cardiologist, coloproctologist, urologist, microbiologist). It is shown that the unshakable priority of treating patients with FG is still urgent surgical intervention in the format of "aggressive surgery", which provides for extremely wide excision of necrotic and non-viable tissues, followed by programmed (stage-by-stage) rehabilitation necrectomy. The issues of laser irradiation and hydropressive wound treatment with ozonated saline solution are touched upon. Adjuvant wound treatment using vacuum therapy and hyperbaric oxygenation are given.

Background: Fournier's gangrene is a necrotising fasciitis type I occurring in the perineal and genital region. The disease expands progressively and still has poor outcome, especially in critical ill patients. This study's focus was placed on the evaluation of risk factors and comorbidities, on the bacteriological spectrum, laboratory analyses, mortality and the course according to the algorithmic approach., Method: The medical records were reviewed of 10 patients with severe Fournier's gangrene from 2010 to 2019 who underwent intensive care therapy for at least 48 hours. Ten patients with Fournier's gangrene and sepsis and intensive therapy lasting at least 48 hours were recorded and analysed descriptively., Results: The patient cohort consisted of six men and four women with a median age of 62 years (range 42 - 78 years). The median time between the onset of symptoms and hospitalisation was four days (range 3 - 5 days). The commonest aetiological event was a minor trauma. Predisposing factors included diabetes mellitus (30%) and overweight (80% BMI > 25). 90% of patients exhibited polymicrobial infection. All patients had systemic sepsis with SOFA-Score between 3 and 17 points. The mortality rate was 40%. Significant differences between surviving and deceased patients were shown by PCT, INR and aPTT (p < 0.05)., Conclusion: Severe Fournier's gangrene continues to be a major challenge with a high mortality rate. Only rapid diagnosis, urgent extensive surgical debridement and intensive care therapy can lead to a favourable outcome in these critically ill patients. Vacuum-assisted closure can be successfully used in the management of soft-tissue defects., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

BACKGROUND Fournier's gangrene is an idiopathic form of necrotizing fasciitis involving the genital and perineal regions; it is associated with high complication and mortality rates. Rarely, perineal infection may be caused by hospital-acquired antimicrobial-resistant bacteria. This report is of a 30-day-old infant with methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae necrotizing fasciitis involving the perineal region. CASE REPORT A 30-day-old male infant presented to the Emergency Department with rapidly progressive white discoloration of scrotal skin since 3 days prior to admission, progressing from 2-3 white spots to covering two-thirds of the scrotal skin. Pain upon urination was noted, with normal appetite and bowel movements. He had a history of diaper rash 6 days earlier accompanied by fever, and the rash was treated with topical antifungal and corticosteroid ointment. He was born at term by caesarean delivery, with birth weight 2900 g. Laboratory examinations revealed leukocyte count 23 000/µL and CRP 26.8 mg/dL. Hemoglobin was 10.6 g/dL, serum sodium was 134 mEq/L, blood glucose was 80 mg/dL, serum urea was 15 mg/dl, and creatinine was 0.27 mg/dL. Chest and abdominal X-rays were normal. He received broad-spectrum antibiotics and underwent surgical debridement, and necrotic tissue was obtained for biopsy and culture. Histology examination showed non-specific granulation tissue consistent with Fournier gangrene. Soft- tissue culture isolated MRSA and ESBL-K. Antibiotics were changed according to the sensitivity report. Blood and urine cultures were negative. CONCLUSIONS Immediate surgery and antibiotics are essential in treating Fournier gangrene to avoid life-threatening complications. Initial symptoms are non-specific. Diagnosis remains primarily clinical, confirmed by intraoperative macroscopic findings.

MiraDry® is a microwave-based cosmetic device commonly used to treat hyperhidrosis and osmidrosis by affecting apocrine and eccrine sweat glands. In most countries, its application is limited to the axillary region. A healthy woman received MiraDry® treatment in the perineal, genital, and perianal regions for body odor in a cosmetic clinic. She experienced severe adverse effects after treatment, including persistent fever, sustained pain, and bleeding in the treated area. The condition deteriorated rapidly with systemic symptoms, and she died on the sixth day. Group A Streptococcus was detected in her skin in the treated areas, and in blood obtained in the hospital and during autopsy. Combined with the clinical diagnosis and autopsy findings, the woman's death was attributed to fatal necrotizing fasciitis (Fournier's gangrene) complicated by streptococcal toxic shock syndrome. Pathogen inoculation was most likely attributable to skin disruption caused by MiraDry® treatment. The MiraDry® application on the genital and perineum is occasionally performed by cosmetic surgeons; however, this case demonstrates the possibility of a rare but fatal complication. Therefore, this case report may be noteworthy and beneficial in forensic practice, and relevant in cosmetic clinical practice., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: To assess the prognostic value of mortality of a new system for quantifying the lesion length circumscribed to the genitals and adjacent anatomical areas in patients with Fournier's gangrene., Methods: An observational, analytical and prospective study in the Urology service of the Arnaldo Milián Castro University Hospital, between January 2007 and December 2019. The sample consisted of 60 patients diagnosed with Fournier's gangrene. To determine the lesion length, a new quantification system was designed by the authors. Its predictive capacity was determined by binary logistic regression analysis and its discriminatory capacity by the area under the ROC curve., Results: In the studied sample, Fournier's gangrene mortality was 26.7%. The logistic regression analysis demonstrated the prognostic value of mortality of the quantification system evaluated, for each point that the extension of the lesion increased, the risk of death increased by approximately five times, thus being superior to the methods previously used to quantify the injury. Results of the calibration of the quantification system by the Hosmer-Lemeshhow test showed that the data were adjusted to the regression equation ( p = 0.278). An area under the curve of 0.957 was observed, which reflects a good discriminatory capacity, showing a sensitivity of 93.75% and a specificity of 93.18%., Conclusions: The system for quantifying the lesion length in patients with Fournier's gangrene proposed in the present study showed an excellent prognostic value for mortality. The integration of this new method into others prognostic scores could substantially increase sensibility and specificity on diagnostic, by means of offering a more precise approach of the lesion dimensions.

Background: Fournier's gangrene (FG) is rapidly progressing and life-threatening necrotizing fasciitis of genital and perineal regions. The aim of the study was to share our experience with FG and to analyze the relationship of clinical data with whole blood count parameters, inflammation cells, and systemic inflammation markers., Methods: The digital medical records of the adult patients followed-up and treated with diagnosis of FG between January 2016 to December 2020 were retrospectively analyzed. Data were as age, gender, total length of hospital stay, predisposing factors, etiological factors, total number of debridement's, surgical procedures, and antibiotherapy were collected. Serum glucose levels, complete blood count parameter levels, serum inflammation indicators and C-reactive protein (CRP) levels measured at the initial day of hospital admission, post-debridement 1st and 7th days were measured., Results: Thirty-six male patients were included, with a mean age of 56.42 (22-86) years. The most common predisposing factor was diabetes mellitus (n=13; 36.1%). The most frequently seen etiological cause was scrotal abscess (n=19; 52.8%). A statistically significant decrease was found in White blood cell count, neutrophil level, neutrophil-to-lymphocyte ratio (NLR) value and CRP level measured before debridement, post-debridement 1st and 7th days (p<0.05). There was a positive correlation between the number of debridement's and age, NLR, platelet-to-lymphocyte ratio, and CRP values at the initial admission time (p<0.05)., Conclusion: The infections of urogenital region are the essential etiological origin of FG. As a rare urological emergency, significant changes were observed in clinical data and blood count parameters during the course of FG.

Background: In the present study, we aimed to determine the risk factors for mortality in Fournier's gangrene (FG), which has a high morbidity and mortality rate and requires urgent surgical intervention., Methods: A retrospective analysis was made of 150 patients who were operated on in our clinic due to FG of anorectal origin be-tween 2010 and 2020. The cases were divided into survival and non-survival groups. Demographic, clinical, laboratory, and treatment data, FG Severity Index (FGSI), and simplified FGSI (SFGSI) scores were analyzed., Results: Thirty-day mortality rate was 15.3%. In the non-survival group, rate of smoking, diabetes mellitus, malignancy and other chronic diseases, and mean age, duration of symptoms at admission, number of debridements, SFGSI, FGSI, white blood cells, and creatinine were significantly higher, while hematocrit, serum potassium, and albumin levels were significantly lower (p<0.05). Among these factors, age (OR=1.147, CI=1.019-1.291; p=0.023), smoking (OR=0.09, CI=0.023-0.418; p=0.002), malignancy (OR=0.038, CI=0.008-0.186; p=0.001), and serum potassium level (OR=0.141, CI=0.022-0.910; p=0.04) were identified as risk factors associated with mortality in FG., Conclusion: FG is a fatal fasciitis still associated with high mortality. Advanced age, smoking, malignancy, and hypopotassemia are independent predictive risk factors for mortality in FG.

In this article, the authors discuss the epidemiology, pathophysiology, and mechanism of spread of necrotizing soft-tissue infections of the genitalia, including classification schemas. The authors then discuss the acute clinical management of the disease, including suggestions for ways to improve surgical debridements (such that eventual reconstructions are simpler), ways to predict disease severity using laboratory, vital sign, and physical examination findings, and suggestions for initial antimicrobial treatments. Finally, reconstructive techniques and algorithms to ensure that the reconstructive goals of coverage, function, and cosmesis are met, are discussed, including the management of postoperative complications., Competing Interests: Disclosure The authors have nothing to disclose., (Published by Elsevier Inc.)

Background: We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier's gangrene., Material and Methods: A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier's gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier's Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated., Results: Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ± 2.5 days. As a result of the statistical analyses, it was found that Fournier's Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier's Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality., Conclusion: Fournier's gangrene is a mortal disease and an emergency condition. With the improvements in Fournier's gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: Many predictive factors and scoring systems associated with Fournier's gangrene have been proposed, including comorbidities, vital signs, biochemical and hematological parameters, and demographic characteristics of the patient. The aim of this study was to determine the strengths of the scoring systems that have been formed by revealing these factors from a wider perspective and in a larger patient population., Methods: The patient population included 144 patients, 21 of whom died. Age, biochemical and hematological parameters, Uludag Fournier's Gangrene Severity Index (UFGSI), Fournier's Gangrene Severity Index (FGSI), and Age-Adjusted Charlson Comorbidity Index (ACCI) scores were analyzed using the Mann Whitney U-test due to their non-parametric distribution. Categorical data such as comorbidities, gender, need for positive inotropes, diversion ostomy status, and UFGSI grading status was analyzed with the Chi-square test, and independent risk factors were determined from the significant data emerging from univariate and multivariate logistic regression analysis. Their strengths were compared using the logistic regression model (Fournier's Gangrene Mortality Prediction Model: FGMPM) created through ROC analysis of the FGSI, UFGSI, and ACCI scores., Results: The results of the statistical analyses showed that albumin (p<0.001) and need for positive inotropic support (p<0.001) were independent risk factors for mortality and ROC analysis revealed that the created FGMPM regression model (AUC: 0.995) was a stronger model than the FGSI (AUC: 0.874), UFGSI (0.893), and ACCI (0.788) scoring systems., Conclusion: The results of this study revealed that albumin and the need for positive inotropic support are independent risk factors for mortality. It is thought that the determination of these two parameters can be used to predict mortality more practically than the parameters used in the UFGSI and FGSI.

BACKGROUND Fournier's gangrene (FG) is a rapidly progressive necrotizing infection of the perineum. Risk factors include male sex and immunosuppression. Inflammatory bowel disease and pregnancy may alter immune response by complex mechanisms but have rarely been associated with necrotizing infections of the perineum. To the best of our knowledge, only 5 cases of FG in association with IBD have been reported in the literature, and none of them occurred during pregnancy. CASE REPORT We report the case of a young woman with long-standing Crohn's disease in clinical remission with Infliximab monotherapy who developed FG in the third trimester of pregnancy. A cesarean section was undertaken at 35 weeks due to fetal distress, followed by debridement, diverting stoma, and vacuum-assisted therapy. The perineal defect was closed following 4 debridements and vacuum-therapy exchanges with a unilateral medial thigh advancement flap, and a draining seton was placed in the suprasphincteric fistula. The patient was discharged after 28 days and her recovery was unremarkable. The neonate also recovered well. CONCLUSIONS The treatment of FG is multidisciplinary and includes early debridement and intestinal diversion. Perianal pain should not be disregarded, as it may be the initial symptom of severe perianal sepsis in the immunosuppressed. To the best of our knowledge, this is the first case report of FG during pregnancy in a patient with Crohn's disease.

Introduction: Fournier's gangrene is a serious infection and is considered a major emergency. A complete assessment of the severity factors using a severity score is essential and makes it possible to adapt the therapeutic management., Aim: Validate Fournier's Gangrene Severity Index and evaluate its benefits in the initial assessment of disease severity., Methods: This is a retrospective, monocentric study which gathered all the cases of perineal gangrene that were managed in General Surgery Department of Habib Bougatfa Hospital in Bizerte over a period of 8 years. The primary endpoint in our study was mortality., Results: Thirty-five cases of Fournier's gangrene were collected. The average age of our patients was 46 years. Mortality rate was 23%. We calculated the Fournier's Gangrene Severity Index for 22 patients. There was a significant difference in the average Fournier's Gangrene Severity Index score between the group of surviving patients (3.75) and the group of deceased patients (12.63) (p 9.5 (sensitivity 87.5%, specificity 100%), we noted that the mortality rate was significantly higher in the group with a score> 10 (100%) than in the group with a score ≤ 9 (6%) (p.

Fournier's gangrene (FG), a necrotizing fasciitis of the genital and perineal region, is a serious and debilitating multi-infective pathological condition. More commonly seen in adults, its occurrence in neonates is uncommon. We share our experience with neonatal FG (NFG), highlighting potential factors which may predispose neonates to it.Ours is a five year retrospective review of cases of NFG in our service. Data obtained included health facility of birth, mode of delivery, symptoms and duration, investigation results, treatment and outcome. Sixteen neonates were included, comprising 13 males (M:F  =  4.3:1). Fourteen were delivered outside our centre; breech vaginal delivery, hot water massaging and application of native concoctions were common. All were treated with antibiotics and wound debridement, but five (37.5%) died.NFG is not that rare in our service. Early recognition is imperative to reduce mortality. Neonates delivered by breech vaginally may be particularly at risk.

Fournier gangrene (FG) is a deadliest condition affecting genitoperineal area in predisposed patients. A late diagnosis, thus a delayed surgical treatment, leads often to death. LRINEC score and CT scan can help in suspect, despite definitive diagnosis needs surgical exploration and histological findings. Furthermore, FG determines wide defects of genitoperineal area, thus reconstructive surgery is pivotal to restore form and function of the affected patient. Aim of this article is to discuss the use of posteromedial thigh (PMT) fasciocutaneous flap in FG reconstruction, based on authors' personal experience. A case report of a 63-year-old obese and diabetic man is presented. Two PMT flaps (10 x 17cm2) were harvested to cover a complete scrotal defect (20 x 40cm2), while penis integuments defect was treated with a two-staged surgery (dermal substitute application and skin graft). Follow-up at 4 months showed a successful outcome of PMT flaps reconstruction, with preservation of testes vitality, despite one of the flaps developed distal necrosis that was treated with further debridement and skin graft. The authors experience is followed by the decision-making process based on a literature review that led to the choice to use PMT flaps to achieve reconstruction. Furthermore, alternative flaps to treat FG, each of them with pros and cons, are discussed, despite there is not a gold standard treatment and every option must be tailored to the patient. KEY WORDS: Fournier gangrene, Genital reconstruction, Infection, Necrotizing fasciitis, Posteromedial thigh flap, Perineum reconstruction.

Background: Fournier's gangrene (FG) is a disease with high mortality rate. The first diagnosis is performed in the emergency department (ED). In this study, we investigated the importance of the time period for diagnosis in the ED., Methods: The data of patients who were treated for FG between 1 January 2010 and 2020 were retrospectively analysed. Waiting period of the patients in ED was calculated. Risk factor score calculations were calculated to predict FG mortality and prognosis. The effects of the ED waiting period on the duration of admission to the hospital, the number of debridements and mortality status and relationship with FG mortality risk factor scores were investigated., Results: In a 10-year period, a total of 66 patients were included in the study. It was found that the median age of the patients was 56 years. ED waiting period median (IQR) was 105 (115) minutes. It was observed that there was a significant positive correlation between the ED waiting period, duration of admission to hospital (rs: 0.537, P < .001) and patients mortality status (rs: 0.482, P < .001). The ED waiting period was higher in patients with FG mortality. It was observed that the ED waiting period holds a diagnostic value in predicting mortality (P < .001). The cut-off limit predicted for this value was determined as 136 minutes., Conclusion: FG is a urological emergency. ED waiting period affects mortality rate and length of hospital stay. The earlier the diagnosis and treatment is conducted in the ED, the lower the mortality rate and length of stay in the hospital will be., (© 2021 John Wiley & Sons Ltd.)