NECROTIZING FASCIITIS OF THE MALE GENITAL REGION– A REVIEW OF THE LITERATURE

摘要

FOURNIER’S GANGRENE (FG) IS AN ACUTE AND RARE, RAPIDLY PROGRESSIVE AND LIFE-THREATENINGFASCIITIS OF THE PERINEAL, GENITAL AND PERIANAL REGION WHICH CAN SPREAD TO THEABDOMINAL WALL AND THIGHS WHICH COMMONLY AFFECTS MEN OVER 50 YEARS OLD. THE MOSTFREQUENT RISK FACTORS INVOLVED IN FG PATHOGENESIS ARE: DIABETES MELLITUS (20-70%) ANDCHRONIC ETHANOL ABUSE (25-50%). PRIMUM MOVENS OF THIS DISEASE IS THE TRAUMA (ACCIDENTALOR IATROGENIC) TO THE ANORECTAL AREA, UROGENITAL APPARATUS OR THE PERINEAL AND GENITALSKIN. DESPITE ADVANCED MANAGEMENT MORTALITY IS STILL HIGH AND AVERAGES 20–30%, THUSEARLY DIAGNOSIS REMAINS IMPERATIVE AS RAPID PROGRESSION CAN LEAD TO SEPSIS ANDMULTIORGAN SYSTEM FAILURE. THE DIAGNOSIS IS MADE MAINLY CLINICAL, BUT IMAGING STUDIESCAN BE HELPFUL TO DESCRIBE THE EXTENT OF THE DISEASE AND SHOULD, UNDER NOCIRCUMSTANCES, DELAY THE SURGICAL DEBRIDEMENT. THE LABORATORY RISK INDICATOR FORNECROTIZING FASCIITIS SCORE CAN BE USED TO STRATIFY PATIENTS INTO LOW, INTERMIDIATE ANDHIGH RISK FOR DEVELOPING FG AND THE FOURNIER’S GANGRENE SEVERITY INDEX CAN BE USED TODETERMINE THE MORTALITY RATE. THE GOLD-STANDARD TREATMENT IMPLIES EXTENSIVE SURGICALDEBRIDEMENT AND BROAD SPECTRUM ANTIBIOTIC THERAPY ASSOCIATED WITH VITAL FUNCTIONSUPPORT THERAPY. THESE PATIENTS ARE OFTEN BEST APPROACHED IN A MULTIDISCIPLINARY TEAM,DUE TO THE FACT THAT THEY MAY NEED RECONSTRUCTIVE PROCEDURES IN THE FUTURE.THIS REVIEW AIMS TO BRING THIS FULMINATING DISEASE WITH A DEVASTATING IMPACT ON PATIENT’SLIFE INTO THE LIGHT AND TO UNDERLINE THE IMPORTANCE OF ITS PROMPT MANAGEMENT. FOR THISA THOROUGH SEARCH WAS CONDUCTED ON THE PUBMED AND UPTODATE DATABASES FOR ALLAPPLICABLE RESEARCH.