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Fournier's gangrene

Key sources
The following summarized guidelines for the evaluation and management of fournier's gangrene are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2023), the World Society of Emergency Surgery (WSES/AAST 2021), the Surgical Infection Society Europe (SIS-E/WSES 2018), the Eastern Association for the Surgery of Trauma (EAST 2018), and the Infectious Diseases Society of America (IDSA 2014).
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Guidelines

1.Classification and risk stratification

Risk stratification: consider using Laboratory Risk Indicator for Necrotising Fasciitis score for an early diagnosis and Fournier's Gangrene Severity Index for prognosis and risk stratification of patients with suspected Fournier's gangrene.
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2.Diagnostic investigations

Clinical examination: consider eliciting a focused medical history and performing a physical examination, including DRE, in patients with suspected Fournier's gangrene.
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  • Laboratory tests

  • CT

3.Medical management

Hemodynamic support: initiate prompt appropriate hemodynamic support in patients with Fournier's gangrene.
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  • Antibiotic therapy

  • Adjunctive treatment

4.Surgical interventions

Surgical management, general principles
Consider planning surgical management of early and delayed surgical sequelae in patients with Fournier's gangrene with a multidisciplinary and skilled team.
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Consider using a multidisciplinary and tailored approach based upon the extent of perineal involvement, the degree of fecal contamination, and the possible presence of sphincter or urethral damage.
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  • Surgical management (timing)

  • Surgical management (technique)

  • Surgical management (revision)

5.Specific circumstances

Patients with urosepsis: use the qSOFA score to identify patients with potential sepsis.
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6.Follow-up and surveillance

Indications for surgical consultation: obtain prompt surgical consultation for patients with aggressive infections associated with signs of systemic toxicity or suspicion of necrotizing fasciitis or gas gangrene.
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