Multimodal management of Fournier’s gangrene with subsequent wound closure techniques

Vijayalakshmi V., Sabari Girieasen M., Deepika S., Kannan R., M. S. Kalyan Kumar


Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompromised, first described in 1883 by the French dermatologist Jean Alfred Fournier. It is a form of necrotizing fasciitis of the perineal, genitourinary and perianal regions mostly in males with a mortality of nearly 20-50%. It is a surgical emergency and requires early diagnosis aided by scores such as laboratory risk indicator for necrotising fasciitis (LRINEC) and FG severity index (FGSI), extensive debridement combined with supportive procedures to manage associated complications and broad-spectrum antibiotics. Management of FG thus required a multimodal approach and emphasis on reconstruction after recovery in patients who survive was crucial to improving the quality of life in these patients. Here we were presenting 7 cases of FG successfully managed at our institution, grouped under the four methods by which wound closure was achieved: fecal diversion and split skin grafting of scrotum, urinary diversion and penoscrotal split skin grafting, delayed primary closure (with and without orchidectomy) and wound healing by secondary intention.


Fournier’s gangrene, Reconstruction, Diversion, split skin grafting, Delayed primary closure

Full Text:



Bozkurt O, Sen V, Demir O, Esen A. Evaluation of the utility of different scoring systems (FGSI, LRINEC and NLR) in the management of Fournier's gangrene. Int Urol Nephrol. 2015;47(2):243-8.

Mallikarjuna MN, Vijayakumar A, Patil VS, Shivswamy BS. Fournier's gangrene: current practices. ISRN Surg. 2012;2012:942437.

Insua-Pereira I, Ferreira PC, Teixeira S, Barreiro D, Silva Á. Fournier's gangrene: a review of reconstructive options. Cent European J Urol. 2020;73(1):74-9.

Sockkalingam VS, Subburayan E, Velu E, Rajashekar ST, Swamy AM. Fournier's gangrene: prospective study of 34 patients in South Indian population and treatment strategies. Pan Afr Med J. 2018;31:110.

Williams N, O’Connell PR, McCaskie A. Bailey & love’s short practice of surgery. 27th ed. The collector’s edition. Productivity Press; 2018.

Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K. Fournier’s gangrene and its emergency management. Postgrad Med J. 2006;82(970):516-9.

Ozturk E, Sonmez Y, Yilmazlar T. What are the indications for a stoma in Fournier's gangrene? Colorectal Dis. 2011;13(9):1044-7.

Akcan A, Sözüer E, Akyildiz H, Yilmaz N, Küçük C, Ok E. Necessity of preventive colostomy for Fournier's gangrene of the anorectal region. Ulus Travma Acil Cerrahi Derg. 2009;15(4):342-6.

Yunusa B, Cassell AK, Konneh S, Clark A, Ikpi E. Management of Fournier’s gangrene in a low resource setting. Clin Res Urol. 2019;2(2).

Wallner C, Behr B, Ring A, Mikhail BD, Lehnhardt M, Daigeler A. Reconstructive methods after Fournier gangrene. Urologe. 2016;55(4):484-8.

Karian LS, Chung SY, Lee ES. Reconstruction of defects after Fournier gangrene: a systematic review. Eplasty. 2015;15:18.

Chen SY, Fu JP, Chen TM, Chen SG. Reconstruction of scrotal and perineal defects in Fournier's gangrene. J Plast Reconstr Aesthet Surg. 2011;64(4):528-34.

Alwaal A, McAninch JW, Harris CR, Breyer BN. Utilities of split-thickness skin grafting for male genital reconstruction. Urology. 2015;86(4):835-9.

Demzik A, Peterson C, Figler BD. Skin grafting for penile skin loss. Plast Aesthet Res. 2020;7:52.