Fournier's disease.

Fournier's gangrene is an aggressive synergistic fasciitis of the perineum. The disease can no longer be considered to be idiopathic; in most cases a urologic, colorectal, or cutaneous source can be identified. Despite antibiotics and aggressive debridement, the mortality rate remains high, particularly in the elderly, in patients with renal failure, and in patients with extensive disease. The presentation is highly variable, necessitating a high index of suspicion. High-risk patients include diabetics, alcoholics, and debilitated and immunosuppressed individuals. As the AIDS population increases, the incidence of Fournier's gangrene may increase as well. In questionable cases, imaging modalities should be performed to allow early diagnosis and to reduce missed diagnoses. Broad-spectrum antibiotics and aggressive debridement remain the hallmarks of treatment. Hyperbaric oxygen therapy and improved local wound care may decrease the extent of tissue destruction. Reconstructive techniques afford better cosmetic results. With early recognition, prompt treatment, improved wound care, and reconstructive efforts, the mortality rates and cosmetic results should continue to improve.