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Streptococcal species
Staphylococcal species
Enterobacteriaceae
Anaerobic organisms
Fungi
PATHOPHYSIOLOGY
Bacteremia is considered a starting link in the mechanism of the
development of necrosis of the fascia.
This initiates the cytokine cascade leading to the damage of the
endothelium
Which in turn activates by means of thromboplastin, a coagulation
cascade with inhibition of fibrinolysis and the formation of
disseminated microthrombosis of vessels feeding the fascia.
In addition, damage to the endothelium leads to extravasation of the
liquid part of the blood, swelling of tissues, leukocyte infiltration, all
leading to the ischemic necrosis of the fascia.
PATHOPHYSIOLOGY
Fournier’s disease proceeds clinically with marked symptoms of
intoxication.
Local manifestations include ulceration in the prepuce, skin of the
penis, or scrotum.
Within a few hours, the genitalia hyperemia increases and tissue
necrosis occurs.
Urination becomes painful and difficult.
The disease lasts from 5 to 8 days.
Symptomatology is characterised by common necrosis of the skin,
subcutaneous tissue, muscles, accompanied by the development of
sepsis, multi-organ failure, leading to death.
SIGNS AND SYMPTOMS
Fever
General discomfort (malaise)
Moderate to severe pain and swelling in the genital and
anal areas (perineal)
Rankness and smell of the affected tissues (fetid
suppuration) leading to full blown (fulminating) gangrene.
Rubbing the affected area yields the distinct sounds
(crepitus) of gas in the wound
INVESTIGATIONS
Complete blood cell count (CBC)
Arterial blood gas (ABG) sampling
Blood and urine cultures
Disseminated intravascular coagulation (DIC) panel
Cultures of any open wound or abscess
Plain radiography should be the initial imaging study. It
may reveal moderate-to-large amounts of soft-tissue gas,
foreign bodies, or scrotal tissue edema.
CT Scan
MECHANISM OF SPREAD OF INFECTION
Infection of superficial perineal fascia (Colles fascia) may
spread to the penis and scrotum via Buck and Dartos
fascia, or to the anterior abdominal wall via Scarpa fascia,
or vice versa.
Colles fascia is attached to the perineal body and
urogenital diaphragm posteriorly and to the pubic rami
laterally, thus limiting progression in these directions.
MANAGEMENT
Broad-spectrum intravenous antibiotics as quickly as possible.
E.g. ciprofloxacin and clindamycin, ampicillin/sulbactam,
ticarcillin/clavulanate, or piperacillin/tazobactam in
combination with an aminoglycoside and metronidazole or
clindamycin.
Surgical debridement of all affected dead (necrotic) skin and
subcutaneous tissue involved, with repeated removal of wound
margins as necessary.
Primary closure of the skin, if possible
Local skin flap coverage
Split-thickness skin grafts
Muscular flaps, which are used to fill a cavity
MANAGEMENT
Hyperbaric oxygen therapy (HBO) has been used as an adjuvant to
surgical and antimicrobial therapy.
Indications include failure of conventional treatment, documented
clostridial involvement, or myonecrosis or deep tissue involvement.
HBO is postulated to reduce systemic toxicity, prevent extension of
necrotizing infection, and inhibit growth of anaerobic bacteria.
Nursing diagnosis
• Activity intolerance
• Anxiety
• Breakdown in physical activity
• Breakdown in the caretaking role
• Breakdown in the continuation of health
• Breakdown in the intra-family processes
• Breakdown in the pattern of sleep
• Breakdown in verbal communications
• Excessive volume of liquids
Nursing diagnosis
• Ineective respiratory patterns
• Lack of knowledge
• Lack of self-care syndrome
• Nutrition exceeding body requirements
• Risk of aspiration
• Risk of breakdown of skin unity
• Risk of infection
• Risk of situational low self-estee
PROGNOSIS