Fournier gangrene is a fulminant form of necrotizing fasciitis that affects the perineal, genital, or perianal regions. It was first described in 1883 by Alfred Fournier, a French dermatologist and venereal specialist.


  • Risk factors: diabetes, peripheral vascular disease, chronic alcohol abuse, immunosuppression, malnutrition


  • Elderly males (most common)
  • Can occur in females and children


  • Usually begins with a bacterial infection
    • Often mixed → aerobic/anaerobic
    • Commonly grow Klebsiella, streptococci, staphylococci, clostridia, Bacteroides, and corynebacteria
  • Microthrombosis of small subcutaneous vessel occurs which leads to gangrene of the skin overlying this region

Physical Exam

  • Pain, tenderness, erythema, and swelling of affected site – perineal, genital, or perianal region
  • Foul smelling discharge
  • Crepitus (due to gas forming organisms)
  • Necrotic patches on overlying skin as condition progresses and inflammation continues to increase


  • CBC: elevated WBC
  • CMP: hyponatremia, metabolic acidosis, concurrent renal failure
  • Serum lactate
  • CRP
  • Procalcitonin
  • ABGs
  • HbA1c
  • Blood culture
  • Wound culture


  • US → subcutaneous gas, cobblestoning (individual subcutaneous fat globules surrounded by fluid), snow globe effect (swirling appearance of heterogenous subcutaneous material)
  • X-ray → subcutaneous gas following fascial plane
  • CT → fat stranding, subcutaneous emphysema, abscess, asymmetric fascial thickening
  • MRI is not recommended for initial diagnosis


  • Surgical emergency! Progresses rapidly and can lead to sepsis with multiple organ failure and death.
    • Surgical debridement → often three to four operations before total debridement is complete
    • Urinary or fecal diversion if necessary. Often unnecessary at initial debridement. 
    • Closing surgical site
      • Vacuum-assisted closure system dressings help with closing and accelerate healing
      • Split thickness skin grafts are the primary choice in covering perineal and scrotal skin defects 
  • Hemodynamic stabilization
  • Broad-spectrum IV antibiotics

Relevant Information

  • Can extend to involve different regions of the body depending on the initial site of infection. Since the blood supply of the testes originates intraabdominally, they are usually spared.


  • Acute renal failure
  • Acute respiratory distress syndrome
  • Cardiac arrhythmias
  • Heart failure
  • Multiple organ failure
  • Bacteremia 
  • Incontinence 

Differential Diagnoses

  • Cellulitis
  • Chancre
  • Epididymitis
  • Orchitis
  • Pyonephrosis
  • Scrotal abscess
  • Scrotal edema
  • Stevens-Johnson syndrome
  • Testicular torsion
  • Toxic epidermal necrolysis
  • Toxic shock syndrome
  • Vasculitis