Fournier's gangrene аs a multidisciplinary problem of purulent septic surgery

Abstract

The article is dedicated to the current problem of pyoseptic surgery, presenting an analytical review of the systematic literature that covers one of the rare forms of necrotizing fasciitis — Fournier’s gangrene. From the perspective of an evolutionary approach, the historical milestones in the formation of scientifi c views on the essence and etiopathogenesis of the disease, its epidemiology, classifi cation, clinical presentation, diagnosis, and treatment are presented. In the context of the defi nition, it is declared that in the modern understanding, “Fournier’s gangrene” implies a particular (specifi c) model of critical conditions in surgery, which is characterized by progressive purulent-necrotic lesions and putrefactive decomposition of fascial and soft tissue structures of the external genitalia, manifesting with systemic endotoxemia, septic shock, and high mortality rates. It is postulated that the intravascular invasion of causative microfl ora is at the basis of the pathogenetic mechanism of Fournier’s gangrene development, resulting in disseminated thrombosis of the microcirculatory bed of the superfi cial fascia of the scrotum. In accordance with the principles of evidence-based medicine, modern methods of diagnosis and treatment are outlined. It is shown that urgent surgical intervention in the format of “aggressive surgery,” with the main component being “manual elimination” of necrotic and non-viable tissues achieved through programmed (staged) sanitation necrectomy, is a priority in the treatment of patients with Fournier’s gangrene. Issues of adjuvant therapy using methods such as laser sanitation, vacuum wound therapy, and hyperbaric oxygenation are discussed. Based on a multifactorial analysis of data from contemporary literature, it is declared that a crucial condition that signifi cantly infl uences treatment outcomes and disease prognosis is a multidisciplinary approach to solving diagnostic and therapeutic tasks involving doctors from related specialties (surgeons, coloproctologists, urologists, dermatologists, intensivists, radiologists, bacteriologists).