Skip to main content
Download PDF

Management of Fournier’s gangrene during the Covid-19 pandemic era: make a virtue out of necessity

Basic and Clinical Andrology volume 32, Article number: 12 (2022) Cite this article

Abstract

Background

Fournier’s gangrene (FG) is a necrotizing fasciitis caused by aerobic and anaerobic bacterial infection that involves genitalia and perineum. Males, in their 60 s, are more affected with 1.6 new cases/100.000/year. Main risk factors are diabetes, malignancy, inflammatory bowel disease. FG is a potentially lethal disease with a rapid and progressive involvement of subcutaneous and fascial plane. A multimodal approach with surgical debridement, antibiotic therapy, intensive support care, and hyperbaric oxygen therapy (HBOT) is often needed.

We present the inpatient management of an FG case during the Covid-19 pandemic period. A narrative review of the Literature searching “Fournier’s gangrene”, “necrotizing fasciitis” on PubMed and Scopus was performed.

Case presentation

A 60 years old man affected by diabetes mellitus, with ileostomy after colectomy for ulcerative colitis, was admitted to our Emergency Department with fever and acute pain, edema, dyschromia of right hemiscrotum, penis, and perineal region. Computed tomography revealed air-gas content and fluid-edematous thickening of these regions. Fournier’s Gangrene Severity Index was 9. A prompt broad-spectrum antibiotic therapy with Piperacillin/Tazobactam, Imipenem and Daptomycin, surgical debridement of genitalia and perineal region with vital tissue exposure, were performed. Bedside daily surgical wound medications with fibrine debridement, normal saline and povidone-iodine solutions irrigation, iodoform and fatty gauze application, were performed until discharge on the 40th postoperative day. Every 3 days office-based medication with silver dressing, after normal saline and povidone-iodine irrigation and fibrinous tissue debridement, was performed until complete re-epithelialization of the scrotum on the 60th postoperative day.

Conclusions

FG is burdened by a high mortality rate, up to 30%. In the literature, HBOT could improve wound restoration and disease-specific survival. Unfortunately, in our center, we do not have HBOT. Moreover, one of the pandemic period problems was the patient’s displacement and outpatient hospital management. For all these reasons we decided for a conservative inpatient management. Daily cleaning of the surgical wound allowed to obtain its complete restoration avoiding surgical graft and hyperbaric oxygen chamber therapy, without foregoing optimal outcomes.

Résumé

Contexte

La gangrène de Fournier (GF) est une fasciite nécrosante causée par une infection bactérienne aérobie et anaérobie qui implique les organes génitaux et le périnée. Les hommes, dans la soixantaine, sont plus touchés avec 1,6 nouveau cas/100 000/an. Les principaux facteurs de risque sont le diabète, les tumeurs malignes, et les maladies inflammatoires de l’intestin. La GF est une maladie potentiellement mortelle avec une atteinte rapide et progressive du plan sous-cutané et fascial. Une approche multimodale, avec débridement chirurgical, antibiothérapie, soins de soutien intensif et oxygénothérapie hyperbare (OHB), est souvent nécessaire. Nous présentons la prise en charge en milieu hospitalier d’un cas de GF pendant la période de pandémie de Covid-19. Une revue narrative de la littérature, recherchant «gangrène de Fournier», «fasciite nécrosante» sur PubMed et Scopus, a été réalisée.

Cas clinque

Un homme de 60 ans, atteint d’un diabète sucré et porteur d’une iléostomie après colectomie pour colite ulcéreuse, a été admis dans notre service d’urgences, avec fièvre et des douleurs aiguës, œdème et dyschromie de l’hémiscrotum droit, du pénis et de la région périnéale. La tomodensitométrie a révélé une teneur en air-gaz et un épaississement fluide-œdémateux de ces régions. L’indice de gravité de la gangrène de Fournier était de 9. Une antibiothérapie rapide à large spectre avec Pipéracilline/tazobactam, imipénème et daptomycine, et un débridement chirurgical des organes génitaux et de la région périnéale avec exposition des tissus vitaux, ont été effectués. Ont été réalisés au chevet du patient, un traitement quotidien des plaies chirurgicales, avec débridement de la fibrine, irrigation par solution saline normale et solution de povidone-iode, et application de gaze iodoforme et grasse, jusqu’à la décharge au 40èmejour postopératoire. Tous les 3 jours, un traitement à base de médicaments d’officine avec pansement à l’argent a été réalisé après irrigation par solution saline normale et solution de povidone-iode, et débridement de la fibrine des tissus, jusqu’à la ré-épithélialisation complète du scrotum au 60ème jour postopératoire.

Conclusions

La GF est grevée d’un taux de mortalité élevé, jusqu’à 30%. Dans la littérature, l’OHB pourrait améliorer la restauration des plaies et la survie spécifique de la maladie. Malheureusement, dans notre centre, nous n’avons pas d’OHB. En outre, l’un des problèmes de la période pandémique était le déplacement du patient et la prise en charge ambulatoire des hôpitaux. Pour toutes ces raisons, nous avons opté pour une prise en charge conservatrice en milieu hospitalier. Le nettoyage quotidien de la plaie chirurgicale a permis d’obtenir sa restauration complète en évitant la greffe chirurgicale et la thérapie en chambre à oxygène hyperbare, sans renoncer à des résultats optimaux.

Mots-clés

Gangrène de Fournier, fasciite nécrosante, urgence urologique, débridement chirurgical.

Background

The Fournier’s gangrene (FG) is a necrotizing fasciitis caused by polymicrobial aerobic and anaerobic bacterial infection that involves genitalia and perineum [1]. Males, in their 60 s, are more affected with 1.6 new cases/100.000/year and the male:female ratio is 10:1. Main recognized risk factors are states of immune system impairment as oldness, alcohol and tobacco consumption, cardiovascular diseases, renal and liver impairment, diabetes mellitus, malignancy and inflammatory bowel disease [2,3,4,5].

FG is a potentially lethal disease with a rapid and progressive involvement of the skin, the subcutaneous fat tissue until fascial planes. Inflammation and oedema lead to obliterating endarteritis with thrombosis of blood subcutaneous vessels and consequent ischemia and necrosis along dartos fascial, Colle’s fascia, Scarpa’s fascia and abdominal wall [6].

FG is a potentially lethal condition with a high mortality rate of 20–30% [7]. The standard of care is a prompt multimodal approach including intravenous fluid resuscitation, broad-spectrum antibiotic therapy, surgical extensive debridement and successive wound cares [8, 9]. In this aggressive disease the time is gold.

In order to improve the knowledge on the field, we describe a case of a male affected by several predisposing conditions at high risk of death for FG, immediately treated with a successful multimodal approach during the Covid-19 pandemic period.

A narrative review of the literature was performed on PubMed and Scopus using as researching terms “Fournier’s gangrene” and “necrotizing fasciitis”. All the available English language full-text original article, case series, case report of interest, published from January 2013 until December 2021, were reported in the Table 1 [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158,159,160,161,162,163,164,165,166,167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185,186,187,188,189,190,191,192,193,194,195,196,197,198]. Review articles, meeting reports and congress poster and abstracts were all excluded.

Table 1 Narrative review of the literature about fournier’s gangrene
Full size table

Case presentation

A 60 years old man affected by diabetes mellitus, Leriche syndrome, with ileostomy after emicolectomy for ulcerative colitis (RCU), was admitted to our Emergency Department with fever, acute pain, oedema, dyschromia of right hemiscrotum, penis, and perineal region (Fig. 1). At the level of the scrotum a visible suppuration was present and vivid pain was evocable.

Fig. 1
figure 1

Emergency Department presentation of the case. Clinical presentation with oedema, dyschromia of right hemiscrotum, penis, and perineal region

Full size image

The blood exams revealed a neutrophilic leukocytosis with 19.1 × 109 white blood cells 83.2% of which neutrophiles, hemoglobin 9.3 g/dl, glucose 314 mg/dl, creatinine 1.2 mg/dl, C-reactive protein 42.7 mg/L, procalcitonin 29.44 ng/ml. The modified Laboratory Risk Indicator for Necrotizing Fasciitis score (LRINEC score) was 7, suspicion for necrotizing fasciitis [61]. The Charlson Comorbidity Index score was of 6, the Fournier’s Gangrene Severity Index was 9 with a risk of death > 75% [199, 200].

The emergency ultrasound exam revealed a marked thickening of the scrotal wall associated with intrafascial anechogen film and multiple hyperechoic spots with posterior echoes as for aerial component.

Computed Tomography revealed an abundant air-gas content in the context of the soft and peripheral tissues at the level of the right scrotal lodge reached the cutaneous plane at the lower pole and more cranially, further gas was localized at the base of the root of the penis, in the paramedian perineum homolaterally up to floor below the ischium pubic branch (Fig. 2). A marked fluid-edematous thickening of the tunics and scrotal walls were present bilaterally but more evident on the right side of the scrotum.

Fig. 2
figure 2

Title. Pre-operative CT-scan. CT-scan revealed air-gas content (green arrow) in the context of the soft and peripheral tissues at the level of the right scrotal lodge. A marked fluid-edematous thickening of the tunics and scrotal walls were present bilaterally but more evident on the right side of the scrotum

Full size image

Intravenous fluid resuscitation and broad-spectrum antibiotics such as Piperacillin/Tazobactam (4.5 gr iv q8h), Imipenem/Cilastatin (500 mg iv q8h) and Daptomycin (700 mg iv q24h) were administered.

A prompt surgical debridement of genitalia and perineal region with an accurate necrotic tissue removal up to exposure of healthy tissue was performed (Fig. 3). A Penrose drain was left in place anterior to the rectum where a more destructive debridement was performed. It was removed on the 4th postoperative day after daily withdrawal due to granulated tissue formation. A single blood transfusion was performed for anemia.

Fig. 3
figure 3

Surgical debridement. Surgical extensive debridement of genitalia and perineal region with exposure of healthy tissue

Full size image

Based on intra-operative scrotal ulcer swab, positive for Escherichia coli, Enterococcus faecium, Streptococcus oralis, Candida albicans, Bacteroides fragilis e Staphylococcus lugdunensis, on the 5th postoperative day, the antibiotic therapy was switched to Piperacillin/Tazobactam (4.5 gr iv q8h), Teicoplanin (600 mg iv q24H) and Fluconazole (400 mg iv q24h). Hemocultures and urinocultures were negative.

High-intensity care was carried on in the next days with a bedside daily surgical wound medications with fibrine debridement, normal saline and povidone-iodine solutions irrigation, iodoform and fatty gauze application, until discharge on the 40th postoperative day (Fig. 4).

Fig. 4
figure 4

Discharge. Clinical condition at discharge

Full size image

Plastic surgeons decide to not perform a skin graft due to an excellent wound improvement with local medication. Every 3 days office-based medication with silver dressing, after normal saline and povidone-iodine irrigation and fibrinous tissue debridement, was performed until complete re-epithelialization of the scrotum on the 60th postoperative day.

Discussion

Predisposing factors to Fournier’s gangrene include all conditions with an impaired micro-circulation and immunosuppression such as diabetes mellitus, obesity, chronic alcoholism, smoking habit, renal and liver failure, malignancies, bowel inflammatory diseases and HIV infection [201,202,203,204]. In our case the patient suffered from diabetes, chronic arteriopathy, RCU for which he carried a colostomy following intestinal resection. The presence of a fecal diversion has certainly improved the wound management and therefore promoted its healing, reducing the contamination of the same with fecal material, ensuring a more accurate hygiene of the scrotal and perineal region [183]. The fact that ileostomy was already well established probably allowed to enjoy the benefits described above without exposing the patient to the typical complications of the creation of a neo-stoma, such as parastomal hernia, incisional hernia, colostomy prolapse, necrosis and stenosis which may necessitate additional surgery [183].

Once described as idiopathic, the FG is secondary to aerobic and anaerobic bacterial infection that involves genitalia and perineum and the cause is recognizable in more than 90% of the cases. In most cases the origin site infection is the ano-rectum (30–50%), uro-genitalia (20–40%) and genital surface (20%) [52]. In an immunodeficient host a polymicrobial flora are usually involved with a synergic mechanism of aggressiveness. The latter was present also in our case with several single-management not aggressive pathogens developing a synergism. Polymicrobial infection is reported as cause in 54% of cases [205].

The onset of this necrotizing fasciitis is insidious with up to 40% of cases asymptomatic. When signs and symptoms are the reason of emergency access, they are characterized by genital and perineal regions pain with little to no visible cutaneous damage in the early stage and erythematous and dusky skin, crepitus of subcutaneous tissue, maleodorant and purulent exudates of perineal and genital regions [206].

A successful management of the Fournier’s gangrene is challenging. The risk of death in about 20% of patients makes FG an emergency health condition [68, 99]. Fluid resuscitation for adequate systemic perfusion, empiric intravenous broad-spectrum antibiotic therapy to reduce the risk of septic shock and a prompt extensive surgical debridement ensured an improvement in prognosis in accordance with current guidelines [207]. The surgery plays a cardinal role because a delay in surgical debridement is associated with a significant increase in mortality [208]. From the review of the literature, a risk of death up-to-date is of 14.3% (Table).

In addition, the necrotizing fasciitis could benefit from hyperbaric oxygen therapy (HBOT) to reduce the spread of anaerobic germs, from the vacuum-assisted closure (VAC) that can be used to promote wound healing physiologically reducing the need for reconstructive surgery with skin graft in the setting of a personalized medicine [206, 209,210,211]. HBOT has been related to a better wound control as an adjuvant treatment by promoting wound healing. It acts as bactericide and bacteriostatic especially over anaerobic bacteria, almost always involved in this necrotizing fasciitis. HBOT increases local circulation and tissue oxygenation which prevents the progression of necrosis; furthermore, HBOT seems have synergism with certain antibiotics [18, 45, 209]. In our case the patient hospitalization was long due to the difficulties related to the COVID pandemic era, the choice to not perform a skin graft and the need for daily medications in order to obtain a natural restitutio of the lesion as possible. This type of management made it possible to avoid the use of common tools for resolving Fournier's gangrene such as HBOT, VAC and surgical graft. In our hospital there is not the HBOT so it would have been necessary to transfer the patient to another hospital and one of the COVID-19 pandemic period problem was the patient’s displacement and outpatient hospital management. For all these reasons we decided for a conservative inpatient management.

Conclusions

FG is burdened of high risk of death and a prompt multimodal approach is mandatory. This necrotizing fasciitis also needs a post-operative rigid management to reduce a risk of relapse and allow a complete restoration. In our case, for reason of necessity, an immediate multimodal approach and a daily cleaning of the surgical wound allowed to obtain its complete restoration avoiding HBOT, VAC or surgical graft without foregoing optimal outcomes.

Availability of data and materials

All data generated or analysed during this study are included in this published article.

Abbreviations

FG:

Fournier’s gangrene

HBOT:

Hyperbaric oxygen therapy

RCU:

Ulcerative colitis

VAC:

Vacuum-assisted closure

iv q8h:

Intravenously every 8 h

References

  1. Rad J, Foreman J. Fournier Gangrene. StatPearls [Internet]. 2021. Treasure Island (FL): StatPearls Publishing; 2022.

    Google Scholar 

  2. Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, Bochkarev YM, Ushakov AA, Beresneva TA, et al. Fournier’s Gangrene: Literature Review and Clinical Cases. Urol Int. 2018;101(1):91–7.

    PubMed  Article  Google Scholar 

  3. Cochetti G, Cottini E, Cirocchi R, Pansadoro A, Lepri E, Corsi A, et al. Laparoscopic conservative surgery of colovesical fistula: is it the right way? Wideochir Inne Tech Maloinwazyjne. 2013;8(2):162–5.

    Google Scholar 

  4. Del Zingaro M, Cochetti G, Gaudio G, Tiezzi A, Paladini A, Rossi de Vermandois JA, et al. Robotic conservative treatment for prostatourethrorectal fistula: original technique step by step. Int Braz J Urol. 2020;46(3):481–2.

    PubMed  Article  Google Scholar 

  5. Rossi de Vermandois JA, Cochetti G, Zingaro MD, Santoro A, Panciarola M, Boni A, et al. Evaluation of surgical site infection in mini-invasive urological surgery. Open Med (Wars). 2019;14:711–8.

    Article  Google Scholar 

  6. Del Zingaro M, Boni A, Paladini A, Rossi De Vermandois JA, Ciarletti S, Felici G, et al. Fournier’s gangrene secondary to locally advanced prostate cancer: case report and review of the Literature. G Chir. 40(6):481–96.

  7. Singh A, Ahmed K, Aydin A, Khan MS, Dasgupta P. Fournier’s gangrene. A clinical review. Arch Ital Urol Androl. 2016;88(3):157–64.

    PubMed  Article  Google Scholar 

  8. Grassi V, Pansadoro A, Cochetti G, Barillaro F, Cottini E, D’Amico F, et al. Pneumoscrotum: report of two different cases and review of the literature. Ther Clin Risk Manag. 2015;9(11):581–7.

    Article  Google Scholar 

  9. Ioannidis O, Kitsikosta L, Tatsis D, Skandalos I, Cheva A, Gkioti A, et al. Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis. FrontSur. 2017;10(4):36.

    Article  Google Scholar 

  10. Bensardi FZ, Hajri A, Kabura S, Bouali M, el Bakouri A, el Hattabi K, et al. Fournier’s gangrene: Seven years of experience in the emergencies service of visceral surgery at Ibn Rochd University Hospital Center. Ann Med Surg (Lond). 2021;30(71): 102821.

    Article  Google Scholar 

  11. Vargo E, Leone G, Barat O, Yunker A, Parekh N. A case of Fournier’s gangrene following a large-volume hydrocelectomy in a diabetic patient managed with SGLT-2 inhibitor therapy. Urol Case Rep. 2021;39: 101834.

    PubMed  PubMed Central  Article  Google Scholar 

  12. Trama F, Illiano E, Bertuzzi G, Chiummariello S, Costantini E. Multimodal approach in a patient with Fournier’s gangrene during the coronavirus pandemic. Urol Case Rep. 2021;39: 101825.

    PubMed  PubMed Central  Article  Google Scholar 

  13. Elahabadi I, Bazmandegan G, Salehi H, Jafari A, Ahmadi J, Kamaib Z. Fournier’s gangrene after missed acute perforated appendicitis: A case report. Clin Case Rep. 2021;9(10):e04989.

    PubMed  PubMed Central  Article  Google Scholar 

  14. de La Torre M, Solé C, Fanjul M, Berenguer B, Arriaga-Redondo M, de Tomás E, et al. Neonatal Fournier’s Gangrene. Pediatr Infect Dis J. 2021;40(10):e384–7.

    Article  Google Scholar 

  15. Winyard JC, Wong A, Rashed H, Mellon JK. Undiagnosed Behçet’s Disease Presenting as Fournier’s Gangrene in a Young Male. Case Rep Urol. 2021;21(2021):1–2.

    Google Scholar 

  16. Gul MO, Sunamak O, Kina U, Gunay E, Akyuz C. Fournier’s Gangrene: Our Five-Year Series and the Role of Vacuum-Assisted Closure in the Treatment. Niger J Clin Pract. 2021;24(9):1277–82.

    CAS  PubMed  Google Scholar 

  17. Rivera-Alvarez F, George A, Ganti L. Massive necrotizing Fournier’s gangrene. Urol Case Rep. 2021;38: 101689.

    PubMed  PubMed Central  Article  Google Scholar 

  18. Michalczyk L, Grabińska A, Banaczyk B, Braszko M, Andrychowicz A, Ząbkowski T. Efficiency of hyperbaric oxygen therapy combined with negative-pressure wound therapy in the treatment strategy of fournier’s gangrene - a retrospective study. Urol J. 2021;18i:6797.

    Google Scholar 

  19. Moon JY, Lee MR, Kim JH, Ha GW. Fournier Gangrene in a Patient With Type 2 Diabetes Mellitus Treated With Dapagliflozin: A Case Report. Ann Coloproctol. 2021;37(Suppl 1):S48-50.

    PubMed  PubMed Central  Article  Google Scholar 

  20. Lahouar R, Naouar S, Ben Khalifa B, Gazzah W, Braiek S, El Kamel R, et al. Isolated Penile Fournier’s gangrene: A very rare entity. Urol Case Rep. 2021;37:101608.

    PubMed  PubMed Central  Article  Google Scholar 

  21. Shah T, Raj Joshi B, Kumar A, Simkhada G, Kumar Gupta R. Isolated duodenal injury presenting as fournier’s gangrene: a case report. Clin Case Rep. 2021;9(6):e04232.

    PubMed  PubMed Central  Article  Google Scholar 

  22. Tsuge I, Matsui M, Kanno T, Kaisho J, Takahashi T, Yamanaka H, et al. Fournier’s Gangrene with Edwardsiella tarda: A Gas Production Case by Bacterial Synergism with Streptococcus anginosus. Plast Reconstr Surg Glob Open. 2021;9(6): e3625.

    PubMed  PubMed Central  Article  Google Scholar 

  23. Duarte I, Outerelo C, Santana A, Guerra J. Fournier Gangrene as a Complication of a Perinephric Abscess After Kidney Transplant: A Case Report. Transplant Proc. 2021;53(4):1281–3.

    PubMed  Article  Google Scholar 

  24. Wong R, Blachman-Braun R, Mann U, Eng A, Lother S, Patel P. Location of residence and mortality for patients diagnosed with Fournier’s gangrene. Can Urol Assoc J. 2020;15(5):E267–71.

    PubMed Central  Article  Google Scholar 

  25. Beecroft NJ, Jaeger CD, Rose JR, Becerra CMC, Shah NC, Palettas MS, et al. Fournier’s Gangrene in Females: Presentation and Management at a Tertiary Center. Urology. 2021;151:113–7.

    PubMed  Article  Google Scholar 

  26. Oyelowo N, Ahmed M, Lawal AT, Sudi A, Adetola Tolani AMM, Fidelis L, et al. Fournier’s gangrene: Presentation and predictors of mortality in Zaria, Nigeria. Ann Afr Med. 20(2):105–10.

  27. Kundan M, Priyadarshi V, Chintamani. Sliding inguinal hernia in a case of Fournier’s gangrene: A rare case. Int J Appl Basic Med R. 2021;11(2):106.

  28. Parkin CJ, Acland G, Ilie V, Clayton S, Merei J, Latif E. Sigmoid diverticulitis leading to Fournier’s gangrene. ANZ J Surg. 2021;91(3):E123–5.

    PubMed  Article  Google Scholar 

  29. Grabińska A, Michalczyk Ł, Banaczyk B, Syryło T, Ząbkowski T. Management protocol for Fournier’s gangrene in sanitary regime caused by SARS-CoV-2 pandemic: A case report. World J Clin Cases. 2021;9(5):1215–20.

    PubMed  PubMed Central  Article  Google Scholar 

  30. Sahra S, Jahangir A, Kandlakunta H, Glaser A. Actinotignum schaalii caught for the second time in fournier’s gangrene! Cureus. 2021;13(2):e13288.

    PubMed  PubMed Central  Google Scholar 

  31. Provenzano D, Lo Bianco S, Zanghì M, Campione A, Vecchio R, Zanghì G. Fournier’s gangrene as a rare complication in patient with uncontrolled type 2 diabetes treated with surgical debridement: A case report and literature review. Int J Surg Case Rep. 2021;79:462–5.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  32. Elbeddini A, Tayefehchamani Y, Davey M, Gallinger J, Hooda N, Aly A, et al. Fournier’s gangrene with dapagliflozin in a rural hospital: a case report. BMJ Case Rep. 2021;14(2): e237784.

    PubMed  PubMed Central  Article  Google Scholar 

  33. Kostovski O, Spasovska O, Trajkovski G, Antovic S, Kostovska I, Tosheska-Trajkovska K, et al. Challenging Treatment of a Female Patient with Extensive Fournier’s Gangrene – Case Report. Prague Med Rep. 2021;122(1):39–44.

    PubMed  Article  Google Scholar 

  34. el Hasbani G, Vargas J, Rodrigue P, van Cott C, Dibartholomeo T, Assaker R. Undiagnosed metastatic ileocecal carcinoma: a rare aetiology for Fournier gangrene. ANZ J Surg. 2021;91(1–2):202–4.

    PubMed  Article  Google Scholar 

  35. Voordeckers M, Noels J, Brognet M, Salaouatchi MT, Mesquita M. Localized Fournier’s Gangrene in “End-Stage” Renal Failure: Multidisciplinary Approach and Integration of Palliative Care. Case Rep Nephrol. 2020;24(2020):1–5.

    Google Scholar 

  36. Sihombing AT, Palgunadi IN, Stefanus D. Complete urethral disruption as a complication of urethral catheterization presenting as scrotal mass: A rare case. Urol Case Rep. 2020;33: 101378.

    PubMed  PubMed Central  Article  Google Scholar 

  37. Maghsoudi LH, Navab M, Pak H. A rare presentation of xanthogranulomatous pyelonephritis and emphysematous pyelonephritis complicated with necrotizing fasciitis of scrotum and perineum (fournier gangrene). Urol Case Rep. 2020;33: 101299.

    PubMed  PubMed Central  Article  Google Scholar 

  38. Zhang N, Yu X, Zhang K, Liu T. A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region. BMC Surg. 2020;20(1):259.

    PubMed  PubMed Central  Article  Google Scholar 

  39. Rakusic Z, Krpan AM, Sjekavica I. Fulminant Fournier’s gangrene in a patient with gastric cancer treated with ramucirumab and paclitaxel. Ther Adv Drug Saf. 2020;17(11):2042098620946556.

    Google Scholar 

  40. Kasbawala K, Stamatiades GA, Majumdar SK. Fournier’s Gangrene and Diabetic Ketoacidosis Associated with Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors: Life-Threatening Complications. Am J Case Rep. 2020;2(21): e921536.

    Google Scholar 

  41. Barone M, Grani G, Ramundo V, Garritano T, Durante C, Falcone R. Fournier’s gangrene during lenvatinib treatment: A case report. Mol Clin Oncol. 2020;12(6):588–91.

    PubMed  PubMed Central  Google Scholar 

  42. Batmaz O, Ucar M, Caylan AE, Gök İB, Vural V. Isolated Penile Fournier’s Gangrene: A Rare Case. Cureus. 2020;12(5): e7953.

    PubMed  PubMed Central  Google Scholar 

  43. Syllaios A, Davakis S, Karydakis L, Vailas M, Garmpis N, Mpaili E, et al. Treatment of Fournier’s Gangrene With Vacuum-assisted Closure Therapy as Enhanced Recovery Treatment Modality. In Vivo. 2020;34(3):1499–502.

    PubMed  PubMed Central  Article  Google Scholar 

  44. Padilla M, Fernández Berisso S, Vietri A, Trinitario L, Liern M, Moreno M, et al. Gangrena de Fournier en un niño con síndrome nefrótico corticorresistente. A propósito de un caso. Arch Argent Pediatr. 2020;118(2):e204–7.

    PubMed  Google Scholar 

  45. Creta M, Longo N, Arcaniolo D, Giannella R, Cai T, Cicalese A, et al. Hyperbaric oxygen therapy reduces mortality in patients with Fournier’s Gangrene. Results from a multi-institutional observational study. Minerva Urol Nefrol. 2020;72(2):223–228.

  46. Hatipoğlu E. Fournier’s Gangrene: Five Years’ Experience from a Single Center in Turkey. Ulus Travma Acil Cerrahi Derg. 2020;26(2):235–41.

    PubMed  Google Scholar 

  47. Elbeddini A, Gallinger J, Davey M, Brassard S, Gazarin M, Plourde F, et al. A Case of Fournier’s Gangrene in a Patient Taking Canagliflozin for the Treatment of Type II Diabetes Mellitus. Am J Case Rep. 2020;24(21): e920115.

    Google Scholar 

  48. Ellegård L, Prytz M. Fournier’s gangrene under SGLT-2 inhibitor therapy: A literature review and case report. Int J Surg Case Rep. 2020;77:692–4.

    PubMed  PubMed Central  Article  Google Scholar 

  49. Lindsay PJ, Gibson LE, Bittner EA, Berg S, Chang MG. Sodium-glucose cotransporter-2 (SGLT2) inhibitor-induced euglycemic diabetic ketoacidosis complicating the perioperative management of a patient with type 2 diabetes mellitus (T2DM) and Fournier’s gangrene: A case report. Int J Surg Case Rep. 2020;77:463–6.

    PubMed  PubMed Central  Article  Google Scholar 

  50. Hyun D woo, Lee BC, Choi JB, Park YM, Jung HJ, Jo HJ. Fournier’s gangrene in a rectal cancer patient. Int J Surg Case Rep. 2020;67:150–3.

  51. Dowd K, Patel B, Blumenthal Z, Rodriguez-Unda N, Bird E. Acute management of Fournier’s gangrene in the setting of massive lymphedema. Urol Case Rep. 2020;28: 101013.

    PubMed  Article  Google Scholar 

  52. Del Zingaro M, Boni A, Rossi de Vermandois JA, Paladini A, Lepri E, Ursi P, et al. Fournier’s gangrene and intravenous drug abuse: an unusual case report and review of the literature. Open Med (Wars). 2019;14:694–710.

  53. Zhang C, Liu Y, Sun XC, Chen LM, Xiao B, Xu CX. Management of Fournier gangrene in perineal region by negative-pressure wound therapy combined with delayed repair. Zhonghua Shao Shang Za Zhi. 2019;35(12):872–5.

    CAS  PubMed  Google Scholar 

  54. Amin A, Blazevski A. A curious case of Fournier’s gangrene. Urol Case Rep. 2019;27: 101001.

    PubMed  PubMed Central  Article  Google Scholar 

  55. Nagano Y, Yakame NK, Aoki H, Yamakawa T, Kondo NI. Fournier’s Gangrene in a Patient with Type 2 Diabetes Mellitus Treated with Empagliflozin: A Case Report. Drug Saf Case Rep. 2019;6(1):11.

    PubMed  PubMed Central  Article  Google Scholar 

  56. Kus NJ, Kim BJ, Ross HM. A case report of necrotizing fasciitis with growth of Actinomyces europaeus and Actinotignum schaalii. J Surg Case Rep. 2019;2019(10):rjz286.

  57. Rodler S, Weig T, Finkenzeller C, Stief C, Staehler M. Fournier´s Gangrene Under Sodium-Glucose Cotransporter 2 Inhibitor Therapy as a Life-Threatening Adverse Event: A Case Report and Review of the Literature. Cureus. 2019;11(9): e5778.

    PubMed  PubMed Central  Google Scholar 

  58. Çalışkan S. Fournier’s Gangrene: Review of 36 Cases. Ulus Travma Acil Cerrahi Derg. 2019;25(5):479–83.

    PubMed  Google Scholar 

  59. Magdaleno-Tapial J, Valenzuela-Oñate C, Martínez-Doménech A, Sánchez-Carazo JL, Pérez-Ferriols A. Image Gallery: Fournier gangrene in a patient with severe hidradenitis suppurativa. Br J Dermatol. 2019;181(3): e59.

    CAS  PubMed  Article  Google Scholar 

  60. Joury A, Mahendra A, Alshehri M, Downing A. Extensive necrotizing fasciitis from Fournier’s gangrene. Urol Case Rep. 2019;26: 100943.

    PubMed  PubMed Central  Article  Google Scholar 

  61. Sparenborg JD, Brems JA, Wood AM, Hwang JJ, Venkatesan K. Fournier’s gangrene: a modern analysis of predictors of outcomes. Transl Androl Urol. 2019;8(4):374–8.

    PubMed  PubMed Central  Article  Google Scholar 

  62. Elshimy G, Correa R, Alsayed M, Jyothinagaram S. Early Presentation of a Rare Complication of Sodium-Glucose Cotransporter-2 Inhibitors 10 Days After Initiation: Case Report and Literature Review. Cureus. 2019;11(7): e5173.

    PubMed  PubMed Central  Google Scholar 

  63. Lin HC, Chen ZQ, Chen HX, He QL, Liu ZM, Zhou ZY, et al. Outcomes in patients with Fournier’s gangrene originating from the anorectal region with a particular focus on those without perineal involvement. Gastroenterol Rep (Oxf). 2019;7(3):212–7.

    Article  Google Scholar 

  64. K R, Biswas R, Bhat P, Sistla S, Kumari S, Kate V. Rare isolation of Fusobacterium varium from a case of Fournier’s gangrene. Anaerobe. 2019;57:82–5.

  65. Louro JM, Albano M, Baltazar J, Vaz M, Diogo C, Ramos S, et al. Fournier’s Gangrene: 10-Year Experience of a Plastic Surgery and Burns Department at a Tertiary Hospital. Acta Med Port. 2019;32(5):368–74.

    PubMed  Article  Google Scholar 

  66. Escobar-Vidarte MF, Hurtado-Burbano DF, Loaiza-Osorio S, Nieto-Calvache AJ. Fournier’s Necrosis Associated With Extraintestinal Amebiasis: A Rare Presentation of a Common Infection. J Obstet Gynaecol Can. 2019;41(5):577.

    PubMed  Article  Google Scholar 

  67. Onder CE, Gursoy K, Kuskonmaz SM, Kocer U, Culha C. Fournier’s gangrene in a patient on dapagliflozin treatment for type 2 diabetes. J Diabetes. 2019;11(5):348–50.

    PubMed  Article  Google Scholar 

  68. Heijkoop B, Parker N, Spernat D. Fournier’s gangrene: not as lethal as previously thought? A case series ANZ J Surg. 2019;89(4):350–2.

    PubMed  Article  Google Scholar 

  69. Mostaghim A, Dhanani M, Ingalls RR. Fournier’s gangrene as an initial manifestation of acute promyelocytic leukemia: A case report and review of the literature. SAGE Open Med Case Rep. 2019;7:2050313X19834425.

  70. Zhou Z, Guo F, Huan J. Fournier’s Gangrene With Septic Shock and Multiple Organ Dysfunction Syndrome. Int J Low Extrem Wounds. 2019;18(1):94–6.

    PubMed  Article  Google Scholar 

  71. Majdoub W, Mosbahi A, Bonbled F. Sudden unexpected death due to Fournier gangrene. Forensic Sci Med Pathol. 2019;15(1):155–8.

    PubMed  Article  Google Scholar 

  72. Aslan N, Yildizdas D, Horoz OO, Ozden O. Fatal Agranulocytosis and Fournier’s Gangrene due to the Use of Metamizole. Indian J Pediatr. 2019;86(3):310–1.

    PubMed  Article  Google Scholar 

  73. AlShehri YA, AlBurshaid H, AlBassam L, AlMutairi K. Management of Fournier’s gangrene with skin grafting by bagging technique of testes: case report. Interdiscip Plast Reconstr Surg DGPW. 2019;8:Doc02.

  74. Moussa M, Abou CM. Isolated Penile Fournier’s gangrene: A case report and literature review. Int J Surg Case Rep. 2019;62:65–8.

    PubMed  PubMed Central  Article  Google Scholar 

  75. Hahn HM, Jeong KS, Park DH, Park MC, Lee IJ. Analysis of prognostic factors affecting poor outcomes in 41 cases of Fournier gangrene. Ann Surg Treat Res. 2018;95(6):324–32.

    PubMed  PubMed Central  Article  Google Scholar 

  76. Overholt T, Hajiran A, Ueno C, Zaslau S. Fournier’s Gangrene of the Penis following a Human Bite Wound. Case Rep Urol. 2018;25(2018):9798607.

    Google Scholar 

  77. Pehlivanlı F, Aydin O. Factors Affecting Mortality in Fournier Gangrene: A Single Center Experience. Surg Infect (Larchmt). 2019;20(1):78–82.

    Article  Google Scholar 

  78. Kranz J, Schlager D, Anheuser P, Mühlstädt S, Brücher B, Frank T, et al. Desperate need for better management of Fournier’s Gangrene. Cent European J Urol. 2018;71(3):360–5.

    PubMed  PubMed Central  Google Scholar 

  79. Kobayashi D, Masubuchi M, Takase T, Ichikawa T, Deguchi T, Yaguchi T. Fournier’s gangrene caused by penetration of a rectal cancer followed by neoadjuvant chemotherapy. Surg Case Rep. 2018;4(1):123.

    PubMed  PubMed Central  Article  Google Scholar 

  80. Pandey S, Sharma D, Aggarwal A, Sharma A. Isolated Fournier’s gangrene of the penis with penile autoamputation. BMJ Case Rep. 2018;2018:bcr2018226862.

  81. Matsuura H, Iwasa K. Fournier gangrene. Cleve Clin J Med. 2018;85(9):664–5.

    PubMed  Article  Google Scholar 

  82. Sen V, Sen P, Sahin MO. Fournier gangrene due to Rhizobium Radiobacter. Pak J Med Sci. 2018;34(4):1027–1029.

  83. Elsaket AE, Maharajh S, Urry RJ. The presentation, management and outcomes of Fournier’s gangrene at a tertiary urology referral centre in South Africa. S Afr Med J. 2018;108(8):671–6.

    CAS  PubMed  Article  Google Scholar 

  84. Takano N, Yatabe MS, Yatabe J, Kato M, Sueoka D, Iguchi S, et al. Fatal Fournier’s gangrene caused by Clostridium ramosum in a patient with central diabetes insipidus and insulin-dependent diabetes mellitus: a case report. BMC Infect Dis. 2018;18(1):363.

    PubMed  PubMed Central  Article  Google Scholar 

  85. Semenič D, Kolar P. Fournier’s Gangrene Does Not Spare Young Adults. Wounds. 2018;30(7):E73–6.

    PubMed  Google Scholar 

  86. Abass-Shereef J, Kovacs M, Simon EL. Fournier’s Gangrene Masking as Perineal and Scrotal Cellulitis. Am J Emerg Med. 2018;36(9):1719.e1-1719.e2.

    Article  Google Scholar 

  87. Wetterauer C, Ebbing J, Halla A, Kuehl R, Erb S, Egli A, et al. A contemporary case series of Fournier’s gangrene at a Swiss tertiary care center—can scoring systems accurately predict mortality and morbidity? World J Emerg Surg. 2018;22(13):25.

    Article  Google Scholar 

  88. Demir CY, Yuzkat N, Ozsular Y, Kocak OF, Soyalp C, Demirkiran H. Fournier Gangrene. Plast Reconstr Surg. 2018;142(1):68e–75e.

    CAS  PubMed  Article  Google Scholar 

  89. Chen Y, Wang X, Lin G, Xiao R. Successful treatment following early recognition of a case of Fournier’s scrotal gangrene after a perianal abscess debridement: a case report. J Med Case Rep. 2018;12(1):193.

    PubMed  PubMed Central  Article  Google Scholar 

  90. Yuan L, Xiong Q, Wang B. Fourier’s gangrene associated with a decubitus ulcer. IDCases. 2018;17(12):149–50.

    Article  Google Scholar 

  91. Katsimantas A, Ferakis N, Skandalakis P, Filippou D. A Rare Case of Localised Isolated Penile Fournier’s Gangrene and a Short Review of the Literature. Case Rep Urol. 2018;9(2018):5135616.

    Google Scholar 

  92. Althunayyan S, Karamitosos E. Fournier’s gangrene in an obese female in third trimester of pregnancy. Saudi Med J. 2018;39(4):415–8.

    PubMed  PubMed Central  Article  Google Scholar 

  93. Pittaka M, Georgiou C, Polyviou P, Kountourakis P, Loizou P, Constantinou I, et al. Fournier Gangrene in a patient receiving chemo–radiation for rectal cancer. Oxf Med Case Reports. 2018;2018(2):omx101

  94. Taylor GM, Hess DV. Fournier gangrene: a rare case of necrotizing fasciitis of the entire right hemi-pelvis in a diabetic female. Oxf Med Case Reports. 2018;2018(2):omx094.

    PubMed  PubMed Central  Article  Google Scholar 

  95. Dos-Santos D, Roman U, Westphalen A, Lovison K, Spencer NF. Profile of patients with Fournier’s gangrene and their clinical evolution. Rev Col Bras Cir. 2018;45(1): e1430.

    PubMed  Article  Google Scholar 

  96. Fukui K, Fujioka M, Ishiyama S. Sacral Pressure Ulcer-induced Fournier’s Gangrene Extending to the Retroperitoneum: A Case Report. Wounds. 2018;30(1):E5–8.

    PubMed  Google Scholar 

  97. Kuzaka B, Wróblewska MM, Borkowski T, Kawecki D, Kuzaka P, Młynarczyk G, et al. Fournier’s Gangrene: Clinical Presentation of 13 Cases. Med Sci Monit. 2018;28(24):548–55.

    Article  Google Scholar 

  98. Goel A, Gupta S, Agarwal A, Shiwach N, Chawda V, Bhagat TS. Fournier’s gangrene: a rare manifestation of Chikungunya fever. Trop Doct. 2018;48(1):36–7.

    PubMed  Article  Google Scholar 

  99. Ghodoussipour SB, Gould D, Lifton J, Badash I, Krug A, Miranda G, et al. Surviving Fournier’s gangrene: Multivariable analysis and a novel scoring system to predict length of stay. J Plast Reconstr Aesthet Surg. 2018;71(5):712–8.

    PubMed  Article  Google Scholar 

  100. Tenório CEL, Lima SVC, Albuquerque AV de, Cavalcanti MP, Teles F. Risk factors for mortality in fournier’s gangrene in a general hospital: use of simplified founier gangrene severe index score (SFGSI). Int Braz J Urol. 2018;44(1):95–101.

  101. Weimer SB, Matthews MR, Caruso DM, Foster KN. Retroperitoneal Necrotizing Fasciitis from Fournier’s Gangrene in an Immunocompromised Patient. Case Rep Surg. 2017;2017:5290793.

    PubMed  PubMed Central  Google Scholar 

  102. Wähmann M, Wähmann M, Schütz F, Sohn C, Schott S, Kremer T, et al. Severe Fournier’s gangrene—a conjoint challenge of gynaecology and plastic surgery. J Surg Case Rep. 2017;2017(12):rjx239.

  103. Wang T, Zhao G, Rui YJ, Mi JY. Bilateral femoral posterior neurocutaneous perforater flap successfully treating Fournier gangrene. Medicine (Baltimore). 2017;96(46): e8720.

    Article  Google Scholar 

  104. Yucel M. Fournier’s gangrene: A retrospective analysis of 25 patients. Ulus Travma Acil Cerrahi Derg. 2017;23(5):400–4.

    PubMed  Google Scholar 

  105. Ureyen O. Predictive value of FGSİ and UFGSİ scoring systems used in the prediction of mortality in patients with fournier’s gangrene: a multi-center study. Ulus Travma Acil Cerrahi Derg. 2017;23(5):389–94.

    PubMed  Google Scholar 

  106. Dell’Atti L, Cantoro D, Maselli G, Galosi AB. Distant subcutaneous spreading of Fournier’s gangrene: An unusual clinical identification by preoperative ultrasound study. Arch Ital Urol Androl. 2017;89(3):238–9.

    PubMed  Article  Google Scholar 

  107. Yanaral F, Balci C, Ozgor F, Simsek A, Onuk O, Aydin M, et al. Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier’s gangrene. Arch Ital Urol Androl. 2017;89(3):208–11.

    PubMed  Article  Google Scholar 

  108. Chia L, Crum-Cianflone NF. Emergence of multi-drug resistant organisms (MDROs) causing Fournier’s gangrene. J Infect. 2018;76(1):38–43.

    PubMed  Article  Google Scholar 

  109. Kordahi AM, Suliman AS. A Case of Fournier’s Gangrene. Eplasty. 2017;17:ic25.

  110. Hong KS, Yi HJ, Lee RA, Kim KH, Chung SS. Prognostic factors and treatment outcomes for patients with Fournier’s gangrene: a retrospective study. Int Wound J. 2017;14(6):1352–8.

    PubMed  PubMed Central  Article  Google Scholar 

  111. Sanders O, Gilbert-Kawai E, Saha R. Intravenous immunoglobulin as adjunctive treatment for Fournier’s gangrene. Br J Hosp Med (Lond). 2017;78(9):530–1.

    Article  Google Scholar 

  112. Ferretti M, Saji AA, Phillips J. Fournier’s Gangrene: A Review and Outcome Comparison from 2009 to 2016. Adv Wound Care (New Rochelle). 2017;6(9):289–95.

    Article  Google Scholar 

  113. Kumar S, Costello AJ, Colman PG. Fournier’s gangrene in a man on empagliflozin for treatment of Type 2 diabetes. Diabet Med. 2017;34(11):1646–8.

    CAS  PubMed  Article  Google Scholar 

  114. Bocchiotti MA, Bogetti P, Parisi A, Rivarossa F, Frenello A, Baglioni EA. Management of Fournier’s gangrene non-healing wounds by autologous skin micrograft biotechnology: a new technique. J Wound Care. 2017;26(6):314–7.

    CAS  PubMed  Article  Google Scholar 

  115. Choi H, Kim YS, Na CH, Shin BS. Fournier’s Gangrene: A Rare Complication of Sweet’s Syndrome. Ann Dermatol. 2017;29(3):387–9.

    PubMed  PubMed Central  Article  Google Scholar 

  116. Sawayama H, Miyanari N, Sugihara H, Iwagami S, Mizumoto T, Kubota T, et al. A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report. Surg Case Rep. 2017;3(1):74.

    PubMed  PubMed Central  Article  Google Scholar 

  117. Lauerman MH, Kolesnik O, Sethuraman K, Rabinowitz R, Joshi M, Clark E, et al. Less is more? Antibiotic duration and outcomes in Fournier’s gangrene. Trauma Acute Care Surg. 2017;83(3):443–8.

    Article  Google Scholar 

  118. Smith MT, Graham JN, Levy EB, Olugbade K, Flores V, Emeruwa C, et al. Penile Preservation With Subcutaneous Transposition During Fournier’s Gangrene. Urol Case Rep. 2017;6(12):81–3.

    Article  Google Scholar 

  119. Baek SO, Park SH, Rhie JW, Han HH. Peri-vulvar reconstruction using internal pudendal artery perforator flap in female Fournier’s gangrene. Int Wound J. 2017;14(6):1378–81.

    PubMed  PubMed Central  Article  Google Scholar 

  120. Huang CS, Sacks CA. Fournier’s Gangrene. N Engl J Med. 2017;376(12):1158.

    PubMed  Article  Google Scholar 

  121. Morais H, Neves J, Maciel Ribeiro H, Ferreira M, Guimarães N, Azenha N, et al. Case series of Fournier’s gangrene: Affected body surface area – The underestimated prognostic factor. Ann Med Surg (Lond). 2017;27(16):19–22.

    Article  Google Scholar 

  122. Okumura K, Kubota T, Nishida K, Lefor AK, Mizokami K. Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier’s Gangrene. Case Rep Surg. 2017;2017:2062157.

    PubMed  PubMed Central  Google Scholar 

  123. Osbun N, Hampson LA, Holt SK, Gore JL, Wessells H, Voelzke BB. Low-Volume vs High-Volume Centers and Management of Fournier’s Gangrene in Washington State. J Am Coll Surg. 2017;224(3):270-275.e1.

    PubMed  Article  Google Scholar 

  124. Kahn BE, Tatem AJ, Mazur DJ, Wren J, Hehemann M, Desai AS, et al. MP79–04 CONTEMPORARY REPORT OF A MULTI-INSTITUTIONAL EXPERIENCE WITH FOURNIER’s GANGRENE. J Urol. 2017;197(4S):e1074.

  125. Misiakos EP, Bagias G, Papadopoulos I, Danias N, Patapis P, Machairas N, et al. Early Diagnosis and Surgical Treatment for Necrotizing Fasciitis: A Multicenter Study. Front Surg. 2017;7(4):5.

    Google Scholar 

  126. Obi A. Isolated Fournier’s gangrene of the penis. Niger J Clin Pract. 2016;19(3):426–30.

  127. Pernetti R, Palmieri F, Sagrini E, Negri M, Morisi C, Carbone A, et al. Fournier’s gangrene: Clinical case and review of the literature. Arch Ital Urol Androl. 2016;88(3):237–8.

    PubMed  Article  Google Scholar 

  128. Faria SN, Helman A. Deep tissue infection of the perineum: Case report and literature review of Fournier gangrene. Can Fam Physician. 2016;62(5):405–7.

    PubMed  PubMed Central  Google Scholar 

  129. Ozkan OF, Koksal N, Altinli E, Celik A, Uzun MA, Cıkman O, et al. Fournier’s gangrene current approaches. Int Wound J. 2016;13(5):713–6.

    PubMed  Article  Google Scholar 

  130. Yoshino H, Kawakami K, Yoshino G, Sawada K. Case of anal fistula with Fournier’s gangrene in an obese type 2 diabetes mellitus patient. J Diabetes Investig. 2016;7(2):276–8.

    PubMed  Article  Google Scholar 

  131. Crowell W, Roberts R, Tarry S. Fungal Fourniers Gangrene in an Immunocompromised Patient. Urol Case Rep. 2015;9(4):1–3.

    Google Scholar 

  132. Taken K, Oncü MR, Ergun M, Eryılmaz R, Demir CY, Demir M, et al. Fournier’s gangrene: Causes, presentation and survival of sixty-five patients. Pak J Med Sci. 2016;32(3):746–50.

  133. Wanis M, Nafie S, Mellon JK. A case of Fournier’s gangrene in a young immunocompetent male patient resulting from a delayed diagnosis of appendicitis. J Surg Case Rep. 2016;2016(4):rjw058.

  134. Sheehy SA, Kelly ME, Francis EC, Sweeney KJ, Hussey A. A rare case of Fournier’s Gangrene. J Surg Case Rep. 2016;2016(5):rjw069.

  135. Sarkut P, Işık Ö, Öztürk E, Gülcü B, Ercan İ, Yılmazlar T. Gender does not affect the prognosis of Fournier’s gangrene: a case-matched study. Ulus Travma Acil Cerrahi Derg. 2016;22(6):541–4.

    PubMed  Google Scholar 

  136. Sinha R, Arachchi A, Lee P, Marwan K. Fournier Gangrene in Pregnancy. Obstet Gynecol. 2015;125(6):1342–4.

    PubMed  Article  Google Scholar 

  137. Chalya PL, Igenge JZ, Mabula JB, Simbila S. Fournier’s gangrene at a tertiary health facility in northwestern Tanzania: a single centre experiences with 84 patients. BMC Res Notes. 2015;28(8):481.

    Article  CAS  Google Scholar 

  138. Namkoong H, Ishii M, Koizumi M, Betsuyaku T. Fournier’s gangrene: a surgical emergency. Infection. 2016;44(1):143–4.

    PubMed  Article  Google Scholar 

  139. Mohor GS, Schulz D, Solovan C. Unusual foreign body in the sigmoid colon, chronic alcohol abuse, and Fournier gangrene: a case report. Clin Interv Aging. 2015;31(10):673–7.

    Article  Google Scholar 

  140. McCormack M, Valiquette AS, Ismail S. Fournier’s gangrene: A retrospective analysis of 26 cases in a Canadian hospital and literature. Can Urol Assoc J. 2015;9(5–6):E407–10.

  141. Tarchouli M, Bounaim A, Essarghini M, Ratbi MB, Belhamidi MS, Bensal A, et al. Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases. Can Urol Assoc J. 2015;9(11–12):E800–4.

  142. Paonam SS, Bag S. Fournier gangrene with extensive necrosis of urethra and bladder mucosa: A rare occurrence in a patient with advanced prostate cancer. Urol Ann. 2015;7(4):507–9.

  143. Oguz A, Gümüş M, Turkoglu A, Bozdağ Z, Ülger BV, Agaçayak E, et al. Fournier’s Gangrene: A Summary of 10 Years of Clinical Experience. Int Surg. 2015;100(5):934–41.

    PubMed  PubMed Central  Article  Google Scholar 

  144. Asahata S, Hirai Y, Ainoda Y, Fujita T, Okada Y, Kikuchi K. Fournier’S Gangrene Caused by Listeria Monocytogenes as the Primary Organism. Can J Infect Dis Med Microbiol. 2015;26(1):44–6.

  145. Ye J, Xie T, Wu M, Ni P, Lu S. Negative Pressure Wound Therapy Applied Before and After Split-Thickness Skin Graft Helps Healing of Fournier Gangrene. Medicine (Baltimore). 2015;94(5): e426.

    Article  Google Scholar 

  146. Danesh HA, Saboury M, Sabzi A, Saboury M, Jafary M, Saboury S. Don’t underestimate fournier’s gangrene: report of 8 cases in 10 month survey. Med J Islam Repub Iran. 2015;2(29):172.

    Google Scholar 

  147. Ossibi PE, Souiki T, Majdoub KI, Toughrai I, Laalim SA, Mazaz K, et al. Fournier gangrene: rare complication of rectal cancer. Pan Afr Med J. 2015;24(20):288.

    Google Scholar 

  148. Sarmah PB, Khan M, Zilvetti M. Fournier’s gangrene secondary to an acutely inflamed appendix herniating into the deep inguinal ring. J Surg Case Rep. 2015;2015(3):rjv027.

  149. Papadimitriou G, Koukoulaki M, Vardas K, Grigorakis A, Vougas V, Drakopoulos S. Fournier′s gangrene due to perioperative iatrogenic colon perforation in a renal transplant recipient. Saudi J Kidney Dis Transpl. 2015;26(6):1257–61.

    PubMed  Article  Google Scholar 

  150. Özşaker E, Yavuz M, Altınbaş Y, Şahin Köze B, Nurülke B. The care of a patient with Fournier’s gangrene. Ulus Travma Acil Cerrahi Derg. 2015;21(1):71–4.

    PubMed  Article  Google Scholar 

  151. Toh JWT, Gibson K, Vanlioglu B, Ang S, Ong E. Rapid progression of perianal abscess into Fournier’s gangrene. ANZ J Surg. 2015;85(3):192–3.

    PubMed  Article  Google Scholar 

  152. Parry N. Fournier gangrene. Clin Case Rep. 2015;3(3):198–9.

    PubMed  PubMed Central  Article  Google Scholar 

  153. Tena D, Losa C, Medina-Pascual MJ, Sáez-Nieto JA. Fournier’s gangrene caused by Actinomyces funkei, Fusobacterium gonidiaformans and Clostridium hathewayi. Anaerobe. 2014;27:14–6.

    PubMed  Article  Google Scholar 

  154. Matilsky D, Lewiss RE, Whalen M, Saul T. Fournier’s gangrene. Case report Med Ultrason. 2014;16(3):262–3.

    PubMed  Google Scholar 

  155. Lee JY, Jung H, Kwon H, Jung SN. Extended negative pressure wound therapy-assisted dermatotraction for the closure of large open fasciotomy wounds in necrotizing fasciitis patients. World J Emerg Surg. 2014;15(9):29.

    Article  Google Scholar 

  156. Di Serafino M, Gullotto C, Gregorini C, Nocentini C. A clinical case of Fournier’s gangrene: imaging ultrasound. J Ultrasound. 2014;17(4):303–6.

    PubMed  PubMed Central  Article  Google Scholar 

  157. Galukande M, Sekavuga DB, Muganzi A, Coutinho A. Fournier’s gangrene after adult male circumcision. Int J Emerg Med. 2014;24(7):37.

    Article  Google Scholar 

  158. Tattersall TL, Thangasamy IA, Reynolds J. Bilateral adrenal haemorrhage associated with heparin-induced thrombocytopaenia during treatment of Fournier gangrene. BMJ Case Rep. 2014;2014:bcr2014206070.

  159. Omisanjo O, Bioku M, Ikuerowo S, Sule G, Esho J. Clinical characteristics and outcome of management of Fournier′s gangrene at the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. Ann Afr Med. 2014;13(4):174–8.

  160. Rubegni P, Lamberti A, Natalini Y, Fimiani M. Treatment of two cases of Fournier’s gangrene and review of the literature. J Dermatolog Treat. 2014;25(2):189–92.

    PubMed  Article  Google Scholar 

  161. Dinc T, Kayilioglu SI, Sozen I, Yildiz BD, Coskun F. Fournier’s Gangrene as a Postoperative Complication of Inguinal Hernia Repair. Case Rep Surg. 2014;2014: 408217.

    PubMed  PubMed Central  Google Scholar 

  162. Dayan JH, Clarke-Pearson EM, Dayan E, Smith ML. Aesthetic scrotal reconstruction following extensive Fournier’s gangrene using bilateral island pedicled sensate anterolateral thigh flaps: A case report. Can Urol Assoc J. 2014;8(1–2):E114–7.

  163. Ludolph I, Titel T, Beier JP, Dragu A, Schmitz M, Wullich B, et al. Penile reconstruction with dermal template and vacuum therapy in severe skin and soft tissue defects caused by Fournier’s gangrene and hidradenitis suppurativa. Int Wound J. 2016;13(1):77–81.

    PubMed  Article  Google Scholar 

  164. Shimizu T, Harada K, Akazawa S, Yamaguchi M, Inozume T, Kawamura T, et al. Identification of the cause of severe skin infection by Fournier transform infrared spectroscopy: A case of Fournier’s gangrene caused by fish bone. J Dermatol. 2014;41(6):547–50.

    PubMed  Article  Google Scholar 

  165. Ho MP, Chou AH, Cheung WK. Fournier’s Gangrene in an Elderly Woman. J Am Geriatr Soc. 2014;62(2):402–3.

    PubMed  Article  Google Scholar 

  166. Aslanidis T, Myrou A, Giannakou-Peftoulidou M. Management of a young female patient with Fournier’s gangrene and Lemierre’s syndrome. Pan Afr Med J. 2014;4(18):275.

    Google Scholar 

  167. D’Arena G, Cammarota A, Musto P. Fournier’s gangrene complicating thrombocytopenia treated with steroids. Lancet. 2014;383(9928):1580.

    PubMed  Article  Google Scholar 

  168. Perkins TA, Bieniek JM, Sumfest JM. Solitary Candida albicans Infection Causing Fournier Gangrene and Review of Fungal Etiologies. Rev Urol. 2014;16(2):95–8.

    PubMed  PubMed Central  Google Scholar 

  169. Sliwinski A, Kavanagh LE, Bolton D, Lawrentschuk N, Crock JG. Fournier’s gangrene - delayed pedicle flap based upon the anterior abdominal wall. Int Braz J Urol. 2014;40(3):423–6.

  170. Agostini T, Mori F, Perello R, Dini M, Russo G lo. Successful combined approach to a severe fournier’s gangrene. Indian J Plast Surg. 2014;47(1):132–6.

  171. Oymaci E, Coskun A, Yakan S, Erkan N, Ucar AD, Yildirim M. Evaluation of factors affecting mortality in Fournier’s Gangrene: Retrospective clinical study of sixteen cases. Ulus Cerrahi Derg. 2014;30(2):85–9.

    PubMed  PubMed Central  Google Scholar 

  172. Eskitascioglu T, Ozyazgan I, Coruh A, Gunay GK, Altiparmak M, Yontar Y, et al. Experience of 80 Cases with Fournier’s Gangrene and “Trauma” as a Trigger Factor in the Etiopathogenesis. Ulus Travma Acil Cerrahi Derg. 2014;20(4):265–74.

    PubMed  Article  Google Scholar 

  173. Yilmazlar T, Isik O, Ozturk E, Ozer A, Gulcu B, Ercan I. Fournier’s Gangrene: Review of 120 Patients and Predictors of Mortality. Turkish Journal of Trauma and Emergency Surgery. Ulus Travma Acil Cerrahi Derg. 2014;20(5):333–7.

  174. Akbulut F, Kucuktopcu O, Sonmezay E, Simsek A, Ozgor F, Gurbuz ZG. Partial penectomy after debridement of a Fournier’s Gangrene progressing with an isolated penile necrosis. Ulus Travma Acil Cerrahi Derg. 2014;20(5):385–8.

    PubMed  Article  Google Scholar 

  175. Coyne C, Mailhot T, Perera P. Diagnosis of Fournier’s Gangrene on Bedside Ultrasoun. West J Emerg Med. 2014;15(2):122.

    PubMed  PubMed Central  Article  Google Scholar 

  176. Li YD, Zhu W, Qiao J, Lin J. Enterostomy can decrease the mortality of patients with Fournier gangrene. World J Gastroenterol. 2014;20(24):7950–4.

    PubMed  PubMed Central  Article  Google Scholar 

  177. Oyaert M, Cools P, Breyne J, Heyvaert G, Vandewiele A, Vaneechoutte M, et al. Sepsis with an Atopobium-Like Species in a Patient with Fournier’s Gangrene. J Clin Microbiol. 2014;52(1):364–6.

    PubMed  PubMed Central  Article  Google Scholar 

  178. Lee G, Hong JH. Fournier Gangrene: An Unusual Presentation Involving the Bulbous Urethra and Forming Free Gas in the Urinary Bladder. J Emerg Med. 2013;44(1):166–8.

    PubMed  Article  Google Scholar 

  179. Abate G, Shirin M, Kandanati V. Fournier Gangrene from a Thirty-Two-Centimeter Rectosigmoid Foreign Body. J Emerg Med. 2013;44(2):e247–9.

    PubMed  Article  Google Scholar 

  180. Anantha R v, Kasper KJ, Patterson KG, Zeppa JJ, Delport J, McCormick JK. Fournier’s gangrene of the penis caused by Streptococcus dysgalactiae subspecies equisimilis: case report and incidence study in a tertiary-care hospital. BMC Infect Dis. 2013;13:381.

  181. Benjelloun EB, Souiki T, Yakla N, Ousadden A, Mazaz K, Louchi A, et al. Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality. World J Emerg Surg. 2013;8(1):13.

    PubMed Central  Article  Google Scholar 

  182. Pastore AL, Palleschi G, Ripoli A, Silvestri L, Leto A, Autieri D, et al. A multistep approach to manage Fournier’s gangrene in a patient with unknown type II diabetes: surgery, hyperbaric oxygen, and vacuum-assisted closure therapy: a case report. J Med Case Rep. 2013;3(7):1.

    Article  Google Scholar 

  183. Eray IC, Alabaz O, Akcam AT, Ulku A, Parsak CK, Sakman G, et al. Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion. Indian J Surg. 2015;77(Suppl 2):438–41.

    PubMed  Article  Google Scholar 

  184. Bjurlin MA, O’Grady T, Kim DY, Divakaruni N, Drago A, Blumetti J, et al. Causative Pathogens, Antibiotic Sensitivity, Resistance Patterns, and Severity in a Contemporary Series of Fournier’s Gangrene. Urology. 2013;81(4):752–9.

    PubMed  Article  Google Scholar 

  185. Park KR, Kim TG, Lee J, Ha JH, Kim YH. Single-Stage Reconstruction of Extensive Defects after Fournier’s Gangrene with an Exposed Iliac Crest and Testes. Arch Plast Surg. 2013;40(1):74–6.

    PubMed  PubMed Central  Article  Google Scholar 

  186. Subramaniam D, Hureibi K, Zia K, Uheba M. The development of Fournier’s gangrene following rubber band ligation of haemorrhoids. BMJ Case Rep. 2013;2013:bcr2013201474.

  187. Sabzi Sarvestani A, Zamiri M, Sabouri M. Prognostic Factors for Fournier’s Gangrene; A 10-year Experience in Southeastern Iran. Bull Emerg Trauma. 2013;1(3):116–22.

    PubMed  PubMed Central  Google Scholar 

  188. Katib A, Al–Adawi M, Dakkak B, Bakhsh A. A three–year review of the management of Fournier’s gangrene presenting in a single Saudi Arabian institute. Cent European J Urol. 2013;66(3):331–4.

  189. Czymek R, Kujath P, Bruch HP, Pfeiffer D, Nebrig M, Seehofer D, et al. Treatment, outcome and quality of life after Fournier’s gangrene: a multicentre study. Colorectal Dis. 2013;15(12):1529–36.

    CAS  PubMed  Article  Google Scholar 

  190. Akilov O, Pompeo A, Sehrt D, Bowlin P, Molina WR, Kim FJ. Early scrotal approximation after hemiscrotectomy in patients with Fournier’s gangrene prevents scrotal reconstruction with skin graft. Can Urol Assoc J. 2013;7(7–8):E481–5.

  191. Bakari AA, Ali N, Gadam IA, Gali BM, Tahir C, Yawe K, et al. Fistula-in-Ano Complicated by Fournier’s Gangrene Our Experience in North-Eastern Region of Nigeria. Niger J Surg. 2013;19(2):56–60.

    PubMed  PubMed Central  Google Scholar 

  192. Avakoudjo D, Natchagandé G, Hounnasso P, Gandaho K, Hodonou F, Tore-Sanni R, et al. Fournier’S gangrene in cotonou, benin republic. J West Afr Coll Surg. 3(3):75–87.

  193. Chan CC, Williams M. Fournier Gangrene as a Manifestation of Undiagnosed Metastatic Perforated Colorectal Cancer. Int Surg. 2013;98(1):43–8.

  194. Chan CC, Shahrour K, Collier RD, Welch M, Chang S, Williams M. Abdominal Implantation of Testicles in the Management of Intractable Testicular Pain in Fournier Gangrene. Int Surg. 2013;98(4):367–71.

  195. Aliyu S, Ibrahim AG, Ali N, Waziri AM. Fournier’s Gangrene as Seen in University of Maiduguri Teaching Hospital. ISRN Urol. 2013;12(2013): 673121.

    Google Scholar 

  196. Ozkan OF, Altýnlý E, Koksal N, Senger S, Celik A. Combining Flexi-Seal and negative pressure wound therapy for wound management in Fournier’s gangrene. Int Wound J. 2015;12(3):364–5.

    PubMed  Article  Google Scholar 

  197. Khan F, Mukhtar S, Anjum F, Tripathi B, Sriprasad S, Dickinson IK, et al. Fournier’s Gangrene Associated with Intradermal Injection of Cocaine. J Sex Med. 2013 Apr;10(4):1184–6. 2013;10(4):1184–6.

  198. Kumar A, Kumar N, Jain A, Kumar R, Vyas H, Bhandari V. Prospective evaluation of risk factors for mortality in patients of Fournier′s gangrene: A single center experience. Indian J Urol. 2013;29(3):161–5.

    PubMed  PubMed Central  Article  Google Scholar 

  199. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40(5):373–83.

    CAS  PubMed  Article  Google Scholar 

  200. Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier’s gangrene. J Urol. 1995;154(1):89–92.

    CAS  PubMed  Article  Google Scholar 

  201. Hagedorn JC, Wessells H. A contemporary update on Fournier’s gangrene. Nat Rev Urol. 2017;14(4):205–14.

    CAS  PubMed  Article  Google Scholar 

  202. Voltolini L, Rapicetta C, Luzzi L, Paladini P, Ghiribelli C, Scolletta S, et al. Lung resection for non-small cell lung cancer after prophylactic coronary angioplasty and stenting: Short- and long-term results. Minerva Chir. 2012;67(1):77–85.

    CAS  PubMed  Google Scholar 

  203. Cochetti G, Lepri E, Cottini E, Cirocchi R, Corsi A, Barillaro F, et al. Laparoscopic conservative treatment of colo-vesical fistulas following trauma and diverticulitis: report of two different cases. Cent Eur J Med. 2013;8(6):790–4.

    Google Scholar 

  204. Cochetti G, Abraha I, Randolph J, Montedori A, Boni A, Arezzo A, et al. Surgical wound closure by staples or sutures? : Systematic review. Medicine (Baltimore). 2020;99(25): e20573.

    CAS  Article  Google Scholar 

  205. Tang LM, Su YJ, Lai YC. The evaluation of microbiology and prognosis of fournier’s gangrene in past five years. Springerplus. 2015;4(1):14.

    PubMed  PubMed Central  Article  Google Scholar 

  206. Lewis GD, Majeed M, Olang CA, Patel A, Gorantla VR, Davis N, et al. Fournier’s Gangrene Diagnosis and Treatment: A Systematic Review. Cureus. 2021;13(10): e18948.

    PubMed  PubMed Central  Google Scholar 

  207. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan Italy 2021. ISBN 978–94–92671–13–4; 2021.

  208. Kabay S, Yucel M, Yaylak F, Algin MC, Hacioglu A, Kabay B, et al. The clinical features of Fournier’s gangrene and the predictivity of the Fournier’s Gangrene Severity Index on the outcomes. Int Urol Nephrol. 2008;40(4):997–1004.

    PubMed  Article  Google Scholar 

  209. Schneidewind L, Anheuser P, Schönburg S, Wagenlehner FME, Kranz J. Hyperbaric Oxygenation in the Treatment of Fournier’s Gangrene: A Systematic Review. Urol Int. 2021;105(3–4):247–56.

    PubMed  Google Scholar 

  210. Franco-Buenaventura D, García-Perdomo HA. Vacuum-assisted closure device in the postoperative wound care for Fournier’s gangrene: a systematic review. Int Urol Nephrol. 2021;53(4):641–53.

    PubMed  Article  Google Scholar 

  211. Baldassarri M, Fallerini C, Cetta F, Ghisalberti M, Bellan C, Furini S, et al. Omic Approach in Non-smoker Female with Lung Squamous Cell Carcinoma Pinpoints to Germline Susceptibility and Personalized Medicine. Cancer Res Treat. 2018;50(2):356–65.

    CAS  PubMed  Article  Google Scholar 

Download references

Acknowledgements

We are thankful to the patient for his cooperation and allowing us to use his medical records in our case report.

Funding

This study was not supported by any external sources of funding.

Author information

Authors and Affiliations

  1. Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy

    Alessio Paladini, Giovanni Cochetti, Angelica Tancredi, Matteo Mearini, Andrea Vitale, Francesca Pastore, Paolo Mangione & Ettore Mearini

Authors
  1. Alessio Paladini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Cochetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angelica Tancredi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matteo Mearini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Vitale
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesca Pastore
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paolo Mangione
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ettore Mearini
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AP, GC and EM were responsible for conception and design. PM and MM acquired the clinical data. FP and GF independently performed online bibliographic searches in order to identify titles and abstracts of interest and GC select full-text to be included. AT, AV, AP and GC took part in either drafting the article and revising it critically for important intellectual content. All authors gave final approval of the version to be published, agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Giovanni Cochetti.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

The patient has given the consent for publication.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Paladini, A., Cochetti, G., Tancredi, A. et al. Management of Fournier’s gangrene during the Covid-19 pandemic era: make a virtue out of necessity. Basic Clin. Androl. 32, 12 (2022). https://doi.org/10.1186/s12610-022-00162-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12610-022-00162-y

Keywords

  • Fournier’s gangrene
  • Necrotizing fasciitis
  • Urologic emergency
  • Surgical debridement

Basic and Clinical Andrology

ISSN: 2051-4190