fournier 's gangrene is a rare and often fulminant necrotising fasciitis of the perineum and genital region frequently due to a synergistic polymicrobial infection .
the condition was first described as a disease of young adults of unknown cause by fournier in 1888 .
others are local conditions like perianal suppurations and urinary tract infection ( uti ) complicating obstructive uropathy .
the study reviewed fournier 's gangrene in relation to aetiology , presentation , management , and outcome .
the study reviewed all patients managed for fournier 's gangrene in umth over a 6-year period between january 2007 and december 2012 .
a written informed consent was obtained from all patients , and written permission was given by the hospital medical and ethical committee .
the diagnosis of fournier 's gangrene ( figures 1 and 2 ) was made on clinical assessment .
patients were resuscitated where necessary with antibiotics ( metronidazole and ceftriaxone ) , intravenous fluids , analgesics , and antitetanus prophylaxis , blood transfusions were also given .
investigations carried out included packed cell volume , urinalysis , blood sugar and chemistry , wound swab and biopsy for microbial culture , and hiv screening .
wound debridement was done for all patients ( some more than once ) under general or spinal anaesthesia .
the definitive management took the form of healing by secondary intention , by secondary closure , skin grafting , and skin flap rotation .
a total of 43 patients were seen over the study period with five excluded on account of incomplete data , leaving 38 for detailed analysis . all patients were males aged 2 weeks to 80 years , with a mean of 37.82  years .  
clinical features at presentation were scrotal pain and swelling in 36 ( 94.74% ) , fever in 19 ( 50.00% ) , scrotal wound discharge in 19 ( 50.00% ) , vomiting in 5 ( 13.16% ) , and dysuria in 4 ( 10.53% ) .  
table 2 showed predisposing conditions , with uti secondary to obstructive uropathy ( bph / urethral stricture ) in 11 ( 28.95% ) patients , peri - anal suppuration , and hiv , in 8 ( 21.05% ) each .
eleven ( 28.95% ) patients were anaemic at presentation ( pcv < 30% ) . wound biopsy and culture revealed mixed organisms ( aerobe and anaerobe ) in 27 ( 71.05% ) , single isolates in 6 ( 15.79% ) , and sterile cultures in 5 ( 13.16% ) .
twenty - six ( 68.42% ) had blood transfusions , 1 or 2 units in 16 ( 42.11% ) patients , while 10 ( 26.32% ) patients had 3 or 4 units transfused .
twenty - eight patients ( 73.68% ) had wound debridement once or twice while 9 ( 23.68% ) patients had 3 or more serial debridements . twenty ( 52.63% ) had flap rotation for skin cover , 4 ( 10.53% ) had skin graft , while in 12 ( 31.58% ) patients skin was covered by secondary closure , and 2 ( 5.26% ) were allowed to heal by secondary intention .
the average hospital stay was 4 weeks with a range of 1 to 7 weeks .
there were 6 ( 15.79% ) mortalities of which 4 ( 10.53% ) were hiv positive , 1 ( 2.63% ) was diabetic , while 1 ( 2.63% ) was both diabetic and hiv positive .
the causes of death were septicaemia and shock in 4 ( 10.53% ) , diabetic ketoacidosis , and acute renal failure in 1 ( 2.63% ) each .
fournier 's gangrene is a rare and often fulminant necrotising fasciitis of the perineum and genital region frequently due to a synergistic polymicrobial infection .
all patients are males with peak age group 3039 years . clinical features of scrotal pain and swelling , fever , and scrotal discharge and sloughing were in keeping with similar studies .
systemic diseases associated with fournier 's gangrene were diabetes , hiv , and alcoholism ; however , this study did not find alcoholism to be associated with fournier 's . local conditions like peri - anal suppuration and uti  
the management of this condition requires urgent and aggressive resuscitative methods with broad spectrum antibiotics , which covers both aerobes and anaerobes , as well as fluids , which may include blood transfusion if necessary .
all patients had serial wound debridement in keeping with the standard in the management of this condition .
some authors advocate suprapubic cystostomy and diverting colostomy to prevent wound contamination , and in this we had no cause to undertake such procedures .
wound closure is advocated once the wound is clean and this reduced hospital stay . in this
study the majority of the patients had wound closure ( in keeping with the previous principle ) , by secondary closure , skin grafting , and flap rotation .
the prognosis is good especially in children and young adults [ 1214 ] ; however , when it is associated with systemic diseases such as hiv ( figure 3 ) and uncontrolled diabetes , the prognosis is dismal as evidenced by high mortality rate in this study among hiv and diabetic patients , as opposed to findings by other authors that diabetes [ 1518 ] has no adverse effect on survival in the disease .
 
 background . 
 fournier 's gangrene is uncommon but increasingly being seen over the last two decades probably due to increasing socioeconomic problems including an upsurge in hiv infection especially in the tropics . 
 patients and methods . 
 the study retrospectively reviewed all patients with fournier 's gangrene managed in umth between january 2007 and december 2012 . 
 results . 
 thirty - eight males aged 2 weeks to 80 years ( mean 37.82 ) were reviewed , with most aged 3039 years ( 13 ( 34.21% ) ) . 
 clinical features were scrotal pain and swelling , 36 ( 94.74% ) , fever , 19 ( 50.00% ) , and discharging scrotal wound , 19 ( 50.00% ) . 
 the predisposing conditions were uti secondary to obstructive uropathy in 11 ( 28.95% ) , perianal suppuration , and hiv , in 8 ( 21.05% ) patients each . 
 wound biopsy culture revealed mixed organisms in 27 ( 71.05% ) . 
 twenty - six ( 68.42% ) had blood transfusions . 
 thirty - seven ( 97.37% ) patients had wound debridement . 
 twenty ( 52.63% ) had flap rotation for skin cover . 
 there were 6 ( 15.79% ) mortalities , of which 4 ( 10.53% ) were hiv positive , 1 ( 2.63% ) was diabetic , and 1 ( 2.63% ) was both diabetic and hiv positive . 
 conclusion . 
 fournier 's gangrene is a fulminant synergistic necrotising fasciitis of the perineum and genitalia with poor prognosis especially when associated with hiv and diabetes , requiringprompt and aggressive management for good outcome . 
1. Introduction
2. Patients and Methods
3. Results
4. Discussion