[Fournier's gangrene].

Background Fornier gangrene is an extremely rare disease of the genitals. This disease is a result of the urogenital tract, anorectal area, and genital skin infections, appearing usually in immunocompromised patients with diabetes, obesity, and malignant neoplasms. The basic treatment of Fournier gangrene includes an emergency surgical intervention combined with antibiotic therapy and detoxification. Methods A review of recent papers comprising studies and reviews published in 2005-2016 was performed. The clinical cases were studied at the Department of Purulent Surgery Central Clinical Hospital No. 1, where 7 patients were diagnosed and treated. Results The etiology, pathogenesis, clinical and laboratory presentation, diagnosis, treatment, and prognosis of Fournier gangrene are described in this article. The authors have described several clinical cases of patients with Fournier gangrene and with necrotic cellulitis and fasciomyositis of anterior abdominal wall, which is a manifestation of Fournier gangrene. Making allowance for the unfavorable epidemiological situation of syphilis in Russia, the increase in the incidence of complicated, atypical chancre, and therefore, the need for differentiation of Fournier gangrene with such manifestations of syphilis as necrotizing, esthiomenous chancre, indurative edema, the appropriate clinical examples are well explained in this article.

Fournier's Gangrene: Literature Review and Clinical Cases.

Cutaneous adverse drug reactions comprise a significant proportion of all adverse drug reactions. They may mimic other dermatologic or systemic illnesses and may cause significant morbidity or mortality. Seven morphologic groups encompass the most commonly encountered cutaneous drug reaction syndromes: exanthematous (maculopapular), dermatitic/eczematous, urticarial, pustular, blistering, purpuric, and erythrodermic. Drug reactions may have significant downstream consequences for the older individual.

Cutaneous Drug Reactions in the Elderly.

Genital Reconstruction following Fournier's Gangrene.

Sir, We have received institutional review board approval from Chonbuk National University Hospital (CUH 2018-01-025) and obtained the patient’s written informed consent to publish the material. A 61-year-old woman with systemic lupus erythematosus (SLE) and secondary antiphospholipid syndrome (APS) presented with a right lower leg lesion that had developed 2 years previously. She was diagnosed with SLE and APS aged 53 years. She presented with facial rash, polyarthritis, leukopenia, thrombocytopenia, and positivity for antinuclear antibody, anti-dsDNA antibody, antiSm antibody, and antiphospholipid antibody. When she visited the hospital for leg ulceration, her disease activity was well controlled with hydroxychloroquine, low-dose steroid (2.5mg/d), and warfarin. Cutaneous ulceration developed after she scratched the lesion, and it had not healed with regular dressing; in addition, the ulcer had become enlarged and painful. She had undergone split thickness skin grafting (STSG) with skin harvested from her thigh in 2015 (Figure 1(a)); however, the lesion showed disruption and became aggravated after 6 months (Figure 1(b)). Subsequently, she underwent STSG again in 2016 (Figure 1(c)), but the wound disrupted again and suppurative inflammation worsened despite surgical debridement (Figure 1(d)). She rejected further surgical intervention and was examined 2 years after the development of the first lesion. Physical examination revealed a 5 4 cm ulcer on the right lower extremity, exhibiting yellowish exudates at the base and undetermined edges with surrounding violaceous, gray erythema. Her blood, urine, and wound cultures did not show any infectious etiology. Biopsy of the skin adjacent to the ulcer revealed diffuse neutrophilic infiltrates, which was non-specific but helpful in excluding other differential diagnoses, such as cutaneous malignancy, infection, or vascular disorders, and led to the diagnosis of pyoderma gangrenosum (PG). High-dose prednisolone (1mg/kg/d) and cyclosporine (2mg/kg/d) were immediately started. The wound substantially healed with re-epithelialization, and the overall diameter decreased to 1.5 cm (Figure 1(e) to (i)). This improvement remained stable at the 12month follow-up. PG is a cutaneous disease characterized by expanding ulcers, and considered an idiopathic neutrophilic dermatosis, possibly driven by a chronic autoinflammatory process of the skin. It has been described in association with systemic medical disorders like SLE. However, patients, especially those with lupus, may have a wide range of skin manifestations, making it difficult to diagnose PG without awareness of its possibility. Recently, diagnostic criteria were proposed by an international experts group, and this approach predominantly relies on clinical features. Furthermore, the PARACELSUS score, which is a new and clinically practical diagnostic scoring system, also includes the presence of systemic diseases as a scoring factor and emphasizes the characteristic clinical features. Therefore, it is important for clinicians to be aware of the possibility of PG in a patient with SLE to prevent misdiagnosis and delayed diagnosis. Currently, glucocorticoids and immunosuppressive agents are the mainstay of treatment on the basis of expert opinions. Surgical intervention has not been proven efficacious; even cases of ‘‘post-surgical pyoderma gangrenosum’’ emphasized that surgical intervention may lead to disease aggravation. Therefore, we present this case to share our experience of misdiagnosis and subsequent inappropriate therapeutic approach in PG and highlight the importance of recognizing this rare disease to enable timely and accurate diagnosis.

https://journals.sagepub.com/doi/pdf/10.1177/0961203318793705

Pyoderma gangrenosum masquerading as an ulcer related to antiphospholipid antibodies in a patient with systemic lupus erythematosus.

Fournier's Gangrene and the Reconstructive Challenges for the Plastic Surgeon

As illustrated by this case, cutaneous PG of the hand is a diagnosis of exclusion. Though rare, an index of suspicion should be maintained as PG can present similarly to other conditions in the hand such as fulminating infection and malignancy, that would traditionally be managed surgically. Inappropriate surgical debridement of PG in the hand can, however, lead to persistent and worsening ulceration and poor outcomes, such as digital amputation, so should be avoided. Although international diagnostic criteria are yet to be established, prompt diagnosis is essential in avoiding significant clinical consequences.

Cutaneous Pyoderma Gangrenosum of the Hand.

DESCRIPTION A previously well 96-year-old woman underwent a hemiarthroplasty of her right hip. She was treated postoperatively with subcutaneous injections of enoxaparin for venous thromboembolic (VTE) prophylaxis, as per hospital protocol. She developed 2 areas of skin necrosis at the location of the injection sites 4 days postoperatively.

Enoxaparin-Induced Skin Necrosis

Salvage of Free Flaps Following Vascular Pedicle Avulsion Using "Supermicrosurgery" Techniques: A Case Report of DIEP Free Flap Salvage and Review of the Literature.

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Fournier's Gangrene and the Reconstructive Challenges for the Plastic Surgeon

Cutaneous Pyoderma Gangrenosum of the Hand.

Enoxaparin-Induced Skin Necrosis

Salvage of Free Flaps Following Vascular Pedicle Avulsion Using "Supermicrosurgery" Techniques: A Case Report of DIEP Free Flap Salvage and Review of the Literature.