Fournier's Gangrene: Complication of a Hospitalized Patient

Fournier’s gangrene is a necrotizing soft tissue infection of the male genitilia caused by polymicrobial infection. A 43 year old African American male with IDDM, HTN, PVD, malnutrition, obesity, ESRD, LBKA, and right diabetic foot ulcer of partially amputated lateral foot, was admitted to the hospital for debridement of foot ulcer and application of VAC therapy. An interdisciplinary team approach was used to care for this patient. The admitting physician, podiatrist, advanced practice CWOCN, CRNP, nutritionist, as well as the infectious disease physician were involved for the care of the right infected diabetic foot ulcer. Patient began antibiotic treatment, podiatrist debrided right foot wound.  CWOCN, CRNP began negative pressure wound therapy (NPWT) to the foot. Patient developed C-diff while on antibiotic therapy and had massive amounts of diarrhea. Fecal contamination of the scrotum occurred and infection of the scrotum diagnosed as Fournier’s gangrene. The urologist and plastic surgeon were involved in OR debridement of the open scrotum with serial OR debridement’s due to the continual diarrhea contamination. The patient was not able to have a fecal management system, nor was a fecal pouch able to stay in place to contain the diarrhea. Patient refused to have a diverting colostomy. After repeated OR wound debridement, CWOCN, CRNP decided to apply negative pressure wound therapy to the open wound of the scrotum. Negative pressure wound therapy was applied to scrotum directly after OR debridement and using y-connector, continued NPWT to the right foot ulcer. The therapy was repeated three times a week for two months, after which the patient was discharged to home with follow up therapy at the wound center. The plastic surgeon followed this patient at the wound center and after four months the wound was fully closed without need for any graft application.