Fournier's Gangrene Research Articles

Sodium-Glucose Cotransporter 2 Inhibitor Use Associated With Fournier's Gangrene: A Review of Case Reports and Spontaneous Post-Marketing Cases.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective for glycemic control and have demonstrated cardiorenal benefits. The U.S. Food and Drug Administration (FDA) released a boxed warning in 2018 regarding the potential development of Fournier's gangrene (FG) with the use of SGLT2 inhibitors. FG is a serious perineal infection with a mortality rate of up to 88% in some cases. To report spontaneous post-marketing cases from the FDA Adverse Event Reporting System (FAERS) database and case reports from the literature of FG associated with the use of SGLT2 inhibitors and to determine whether correlations exist with specific agents. A search of the FAERS database was conducted to identify reported cases of FG associated with the use of any FDA-approved SGLT2 inhibitor between 1 March 2013 and 30 June 2020. Additionally, a literature search was conducted of PubMed, Embase, and the Cochrane library using PRISMA guidelines to identify case reports of FG with the use of SGLT2 inhibitors up to 9 October 2020. A total of 491 cases from the FAERS database were included for review. Descriptive analysis depicted more cases in the empagliflozin, canagliflozin, and dapagliflozin groups than in the ertugliflozin group. Nine case reports were included from the literature review; four attributed to dapagliflozin, three to empagliflozin, and two to canagliflozin. The median ages from cases reported in the FAERS database and from the literature review were 54 and 52 years, respectively. In both datasets, males had a higher incidence of FG than females. Additional data reported include clinical outcomes and concomitant antihyperglycemic medications. Consistent findings are noted in this systematic review and warrant further investigation to elucidate the association between SGLT2 inhibitor use and the development of FG. These results may drive enhanced prescribing patterns to consider patient-specific risk factors and timely monitoring, especially as more indications are approved related to these medications' cardiorenal protective properties.

Fournier's gangrene: Seven years of experience in the emergencies service of visceral surgery at Ibn Rochd University Hospital Center

IntroductionThis work aims to describe and discuss the epidemiological, clinical, therapeutic and evolution of Fournier's gangrene. Materials and methodsCase series with retrospective data collection of patients treated for Fournier's gangrene between January 2010 and March 2017. The main etiologies, risk factors, postoperative complications outcomes and long term follow up results were analyzed. ResultsEight four (84) patients were recruited. The average age of our patients was 49 years (with limits of 20–76), the male gender dominates our series (83.33%) with a sex ratio of 5 M/1W, the most frequently found risk factor was diabetes mellitus (37%). The most common etiology was anal abscesses (32%). The average time to consultation was 8 days (limits ranges from 3 to 30 days). All patients were admitted at a necrosis stage (100%). Anemia was identified in 85% of cases. The low platelets were noticed in 44.03% of cases. Hypoalbuminemia was found in 93% of cases. All patients (100%) benefited resuscitation initially and antibiotic therapy on their admission. They received emergency surgical debridement with a cleansing stoma. The average length of hospital stay was 13 days and complications occurred in 33% of cases. The mortality rate was 7.14%. ConclusionFournier's gangrene is a medico-surgical emergency with a high morbidity and mortality rate. Early diagnosis as well as antibiotic therapy and the quality of debridement save the patients.

Fournier's gangrene complicating severe acute pancreatitis: a case report and literature review

Abstract Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis (EPN). Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported. However, extension of retroperitoneal necrosis to the scrotum causing Fournier's gangrene is uncommon. We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation. He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay. During the 3rd month of hospital stay, the patient started developing pain and ulceration over the scrotum. He was diagnosed with Fournier's gangrene based on clinical examination and was planned for debridement. During surgery, the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination. The case highlights a rare but potentially fatal complication of Fournier's gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement. Concomitant management of two potentially fatal conditions poses numerous challenges.

Fournier's Gangrene: Our Five-Year Series and the Role of Vacuum-Assisted Closure in the Treatment.

Fournier's Gangrene (FG) is the necrotizing fasciitis of the perineal region. To compare the effectiveness of debridement alone and debridement with vacuum-assisted closure in the treatment of Fournier's gangrene. Twenty-two patients operated for FG were analyzed retrospectively. Debridement-only and debridement + VAC treatment groups were compared in terms of age, gender, predisposing factors, comorbid diseases, intensive care unit and hospital stay durations, laboratory results, septic shock, treatment methods, Fournier' gangrene severity index (FGSI) and mortality. The M/F ratio was 13/9. There were 10 and 12 patients in debridement-only and debridement + VAC groups, respectively. Ten patients (45.5%) were admitted to intensive care unit, 8 (36.4%) needed colostomy and 7 (31.9%) developed septic shock, respectively. The mortality rate was 27.3%. There was no significant difference in terms of age, gender, laboratory parameters, number of debridement, length of stay in intensive care unit and hospital, shock duration, and mortality (P > 0.05). The FGSI scores also did not show any difference between the groups which showed that the severity of the disease in both groups are similar. The VAC treatment was found not to provide a statistically significant benefit on mortality. Early and adequate debridement and antibiotic are still the most important factors in the treatment of FG and to reduce mortality.

MP35-08 CLINICAL CHARACTERISTICS ASSOCIATED WITH WOUND CLOSURE IN PATIENTS WITH FOURNIER'S GANGRENE: A SINGLE TERTIARY INSTITUTION EXPERIENCE

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP35)1 Sep 2021MP35-08 CLINICAL CHARACTERISTICS ASSOCIATED WITH WOUND CLOSURE IN PATIENTS WITH FOURNIER'S GANGRENE: A SINGLE TERTIARY INSTITUTION EXPERIENCE Michael Pintauro, Christopher Staniorski, Michelle Yu, Benjamin Davies, Bruce Jacobs, and Paul Rusilko Michael PintauroMichael Pintauro More articles by this author , Christopher StaniorskiChristopher Staniorski More articles by this author , Michelle YuMichelle Yu More articles by this author , Benjamin DaviesBenjamin Davies More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , and Paul RusilkoPaul Rusilko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002044.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fournier’s gangrene (FG) is a surgical emergency requiring early aggressive debridement of infected tissue. The subsequent defect must then close either via primary or secondary intention, the latter often with adjunct graft or flap to bridge gaps in tissue. To date, no study has analyzed associations between patients with closed and unclosed wounds. We sought to identify factors associated with wound closure during index hospitalization. METHODS: We retrospectively reviewed all cases of FG using the electronic medical records system at a single tertiary care hospital from 2016-2020. All patients who underwent at least one debridement were identified and stratified into wound closure during index hospitalization versus no wound closure. Patients who expired during hospitalization were excluded. We analyzed patient data including age, gender, median body mass index (BMI), diabetes (DM) rate, congestive heart failure (CHF) rate, smoking status, Fournier’s Gangrene Severity Index (FGSI), need for suprapubic tube, median length of stay (LOS), use of vacuum assisted closure (VAC) devices, and median number of surgical operations. RESULTS: A total of 72 patients were identified at our institution with 45 (63%) patients undergoing wound closure (Table 1). The majority of patients were male (76%) and were smokers (58%). There were no significant differences in age, BMI, smoking status, FGSI, DM, LOS, number of operations, and suprapubic tube need. The median [interquartile range] LOS was 16 [13, 33] days and was not different between the two groups. There was a statistically significant association between unclosed wounds and CHF (22.2% vs. 4.4%, p=0.046). As expected, VAC usage was statistically different with 33 (77%) of closed wounds and 25 (93%) of unclosed wounds (p=0.02). CONCLUSIONS: This is the first single-center study directly examine associations between wound closure and patient demographics and hospital course. Our institutional study demonstrated CHF and VAC usage as the statistically significant association with delayed wound closure. Interestingly, there was no difference between number of operations, need for suprapubic tube, FGSI, or LOS - factors which may portend worse disease state - and wound closure rate. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e629-e630 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Pintauro More articles by this author Christopher Staniorski More articles by this author Michelle Yu More articles by this author Benjamin Davies More articles by this author Bruce Jacobs More articles by this author Paul Rusilko More articles by this author Expand All Advertisement Loading ...

Risk Factors for Mortality in Fournier's Gangrene: Necrotizing Fasciitis in Perineum and Perianal Region, a Single-hospital Experience

目的：福尼爾氏壞疽是會陰部，生殖器和肛周區域迅速發展且死亡率很高的壞死性筋膜炎。這篇研究呈現福尼爾氏壞疽死亡率的危險因素的探討與分析。方法：這是一項回顧性研究，收集從2009年1月到2019年12月在單一醫院治療的85名福尼爾氏壞疽患者。通過單變量分析和邏輯回歸，評估了臨床特徵、檢驗數據和簡化的福尼爾氏壞疽嚴重指數評分（SFGSI）與死亡率的關聯性。結果：在85位患者中，有70名（82.4%）為男性，平均年齡為62.2 ± 15.4（29－95）歲，主要合併症是糖尿病48位（56.5%）和高血壓38位（44.7%）。其中有6位患者沒有存活，死亡率為7.1%。統計結果顯示壞疽病變擴展至腹壁（OR = 78.0, CI = 6.15-989.03; p = 0.044）及肝硬化（OR = 20.28, CI = 3.14-131.17; p = 0.022）與死亡率有顯著相關。結論：福尼爾氏壞疽病變擴展至腹壁和肝硬化是導致死亡的獨立危險因子。簡化的福尼爾氏壞疽嚴重指數評分（SFGSI）與死亡率有相關性，在本研究中並無顯著意義。

Coexistence of human immuno deficiency virus, diabetes mellitus, epididymal cysts, and Fournier's gangrene: A case report

Fournier's gangrene (FG) is a form of necrotizing fasciitis that is localized in the external genital organs and perianal region and causes skin and subcutaneous tissue gangrene. The clinical picture may vary depending on the patient's comorbidities and the extent of infection; Many predisposing conditions such as immunodeficiency, diabetes, alcoholism encourage the spread of the infection. In this case report, we highlighted the importance of emergency debridement in patients with multiple comorbidities by presenting the Fournier's Gangrene case in a 57-year-old immunosuppressive male patient with cystic lesions in the epididymis, with a history of hypertension, coronary artery disease, diabetes, HIV (human immunodeficiency virus) and a history of bipolar disorder. The patient, who was operated on for debridement by the urology, was given 1x500mg daptomycin, 3x1g meropenem, 3x450mg clindamycin IV treatment. The patient was discharged with full recovery after 17 days of hospitalization. Clinical suspicion in Fournier's gangrene cases, early surgical debridement, and extended-spectrum anti biotherapy are important. with rapid diagnosis and treatment in patients with improvement can also be seen in patients with comorbidities.

AML-215: Successful Management of an Unusual Fournier’s Gangrene Secondary to Post-Transplant AML

Fournier's Gangrene is known to be one of the rarest and potentially lethal necrotizing infections of the perineum and genital region with high mortality. We report an unusual case of a 34-year-old male presenting to Saint Antoine Hospital in June 2020 after 6 months of severe pain, a mass in the anal and perineal area with blackish discoloration, and painful swelling of the scrotum and the penis. A likely diagnosis of necrotizing fasciitis associated with high-grade fever and sepsis was made. An immediate surgical debridement, colostomy, and suprapubic catheter were done, along with broad-spectrum antibiotics. Per medical history, in 1999, he had an amputation of the left foot after diagnosis with osteosarcoma and lung metastasis, followed by chemotherapy. A new evaluation was done in 2003 and showed progressive lung lesions treated with right lobectomy. In January 2010, the patient presented a blood test with pancytopenia and 14% of circulating blasts. Bone marrow aspiration (BMA) was done and showed an AML secondary to chemotherapy (t-AML) with complex karyotype of chromosome 5 and chromosome 17. Induction chemotherapy with 4 cycles of Vidaza + Revlimid from January 2010 to April 2010 led to partial response. In May 2010, bone marrow biopsy showed signs of dysmyelopoiesis with young elements of a dispersed blastic appearance of myeloid origin without excess blasts and no signs of osteosarcoma. In June 2010, the patient had a successful haploidentical allotransplant from his brother. After presenting with Fournier's Gangrene in June 2020, his blood tests showed anemia (Hb 8.6g/dL), thrombocytopenia (127g/L), and blast cells (12%). Biopsies of the genital mass showed diffuse proliferation of malignant cells, and immunohistochemistry tests came back as CD34+, CD117+, MPO-, Glycophorine +/-, CD68-/+, ACL-/+, CD163-, AE1/AE3-, Ki67%, and EBER-. BMA showed a rich marrow invaded by 50% of blasts with a cytologic aspect of AML. After controlling the Fournier's Gangrene by surgery and antibiotics, the patient was started on a new line of treatment with Vidaza/Venetoclax (July 2020). A new BMA done in September showed a complete biologic response with 1% blasts. The decision was made to continue 4 cycles of chemotherapy. The recovery phase was uneventful with satisfactory cosmetic results.

Fournier's Gangrene in Patients with Oncohematological Diseases: A Systematic Review of Published Cases.

Patients suffering from hematological malignancies are at increased risk of Fournier’s gangrene (FG) due to immunosuppression caused by the disease itself or by disease-related treatments. A systematic review of PubMed, ISI Web of Knowledge, and Scopus databases was performed in June 2021. We included full papers that met the following criteria: original research, human studies, and describing clinical presentation, treatment, and outcomes of FG in patients with oncohematological diseases. We identified 35 papers published from 1983 to 2021 involving 44 patients (34 males, 8 females) aged between 4 days and 83 years. The most common malignant hematological disorders were acute myeloid leukemia (n = 21) and acute lymphocytic leukemia (n = 9). In 10 patients FG represented the first presentation of hematological malignancy. Scrotum (n= 27) and perineum (n = 11) were the sites most commonly involved. Pseudomonas aeruginosa (n = 21) and Escherichia coli (n = 6) were the most commonly isolated microorganisms. Surgery was performed in 39 patients. Vacuum-assisted closure and hyperbaric oxygen therapy were adopted in 4 and in 3 patients, respectively. Recovery was achieved in 30 patients. FG-related mortality was observed in 11 patients. FG should be carefully considered in patients with oncohematological diseases.

Efficiency of Hyperbaric Oxygen Therapy Combined with Negative-Pressure Wound Therapy in the Treatment Strategy of Fournier's Gangrene -A Retrospective Study.

Fournier's gangrene (FG) is a serious, aggressive, and often fatal multi-organism infection that affects the soft tissues of the perineum, rectum, and external genitalia. This study aimed to analyse the treatment's strategies of FG. This was a retrospective study of 35 patients with a diagnosis of FG admitted between 2016 and 2021. The diagnosis of FG was established on a clinical basis. Data on patient's age, sex, comorbidities, laboratory results (C-reactive protein (CRP), white blood cell (WBC), hematocrit (HCT), platelets (PLT), sodium, potassium, creatinine, procalcitonin, international normalized ratio (INR), and gangrene culture), extent of resection, antibiotics used, and hospitalisation time were obtained. The extent of resection was assessed on a scale of 1-5. The study group consisted of all men (n=35) aged 24-85 (mean, 58) years. In 13/35 (37%) patients, hyperbaric oxygen therapy (HBOT) combined with negative-pressure wound therapy (NPWT) was used as a treatment for wound healing in Fournier's syndrome (group 1), and in 22/35 (63%) patients, open standard wound care was used (group 2). There were no fatalities in group 1, but four deaths (18%) were noted in group 2.The median extent of resection was 3 in group 1 and 2 in group 2. There was a correlation between the extent of resection and use of HBOT combined with NPWT. The hospitalisation time was much shorter in group 2 (mean, 23days) than in group 1 (mean, 26days). HBOT and NPWT (group 1) showed advanced wound healing with a high efficiency rate. The longer median hospitalisation time in this group may be related to the severity of injury.

Fournier Gangrene Severity Index and Diabetes Mellitus: A Significance Correlation among Fournier Gangrene Patients in Single Center Hospital

BACKGROUND: Fournier gangrene (FG) is an urological emergency in the form of progressive necrotizing fascitis caused by polymicrobial infection which affects the perineum and external genitalia. FG that is not diagnosed and treated properly will result in severe morbidity and even mortality for the patient. The assessment of FG becomes clearer with the creation of a scoring system that predicts patient prognostic and therapeutic outcomes, known as the Fournier ganggreen severity index (FGSI). This FGSI includes clinical and laboratory examinations, namely, temperature, pulse, respiratory rate, levels of sodium, potassium, leukocytes, hematocrit, and blood serum bicarbonate. AIM: We aimed to present descriptive retrospective study, which examined the relationship between age and DM with FGSI in FG patients at the Regional General Hospital. METHODS: Data were taken from January 2017 to December 2020 at the Urology Department, dr. Moewardi Hospital Surakarta. There were 32 cases of FG patients, consisting of 20 patients with diabetes mellitus (DM) and 12 non-DM patients. RESULTS: This study found that FG patients with an FGSI score <9 were 24 patients (75%), FG patients with an FGSI score of >9 were 8 patients (25%). Judging by the distribution of the FGSI score according to the age of the FG patient using the chi-square technique, the value p = 0.045. The p-value <0.05 means that at the 5% significance level the difference in the proportion of FGSI scores between age categories of FG patients is significant. The distribution of the FGSI score according to the DM comorbid showed that there were nine patients with an FGSI score of >9 (45.5%) with comorbid DM and no patients without the DM comorbid. Result of statistical test using the Chi-square technique was p = 0.036. The p-value < 0.05 means that at the 5% significance level the difference in the proportion of FGSI scores between patients with and without comorbid DM is significant. CONCLUSION: Judging by the distribution of the FGSI score, it can be concluded that there is significant relationship between the age of the FG patient and the FGSI score and there is a significant relationship between the DM comorbid and the FGSI score in FG patients at dr. Moewardi Hospital Surakarta in the period January 2017 to December 2020.

Juvenile Gangrenous Vasculitis of the Scrotum: A Case to Consider

We present the case of a 27-year-old male patient who presented with fever and scrotal ulcer after pharyngotonsillar symptoms. The differential diagnosis with other entities that present with scrotal ulcer is proposed, including Fournier's gangrene and vascular ulcer secondary to infection by the SARS-CoV-2 virus.

Experience in the treatment of Fournier's gangrene in a hospital of the Far North

The article presents several clinical observations about the experience of treating Fournier's gangrene in a hospital in the Far North.

Features of the course of Fournier’s gangrene in patients with diabetes mellitus

Fournier’s gangrene (FG) is a septic process accompanied by tissue necrosis of the scrotum, penis and perineum, as well as systemic inflammatory syndrome and endotoxicosis. FG is associated with long hospital stay and high mortality. In recent decades, there has been an increase in the incidence of this pathology, as evidenced by the indicators of the “database of the treated case” in Kyrgyzstan. This fact is associated with the growth of immunocompromised patients and, first of all, patients with diabetes mellitus. The result of treatment depends on the correct tactics, time and volume of emergency surgery. This article presents a 5-year experience of treating patients with FG against the background of diabetes mellitus in the department of purulent surgery of the National Hospital in Bishkek.

Penile Calciphylaxis

A 66-year-old male presented with five days of penile pain and ulceration. The patient had a history of stage 5 chronic kidney disease and repeatedly declined hemodialysis. Wound and urine cultures were unrevealing. CT of the abdomen and pelvis did not reveal any evidence of Fournier's gangrene but identified diffuse severe calcific vasculopathy. Urology and dermatology agreed on the diagnosis of penile calciphylaxis. While diagnosis of calciphylaxis often includes histologic evidence of obstructive vasculopathy, biopsy of penile calciphylaxis is contraindicated due to increased morbidity and mortality. Management focuses wound care and correction of electrolyte abnormalities responsible for calcium deposition.

Fournier s gangrene: etiology, treatment outcomes and factors affecting mortality in 38 patients

Aim: Fournier's gangrene (FG) is a rare, rapidly progressing and life-threatening disease of the genital, perianal and perineal regions. We aimed to evaluate etiological parameters, accompanying diseases, current treatment methods and factors affecting mortality in patients with FG. Method: The medical records of 38 patients who were operated by the same team with a diagnosis of FG from December 2015 to January 2021 were retrospectively reviewed. Those patients were divided into two groups: survivors (Group 1), and non-survivors (Group 2). Comparisons were made regarding clinical and demographic features; comorbid diseases; leukocyte count at first presentation; etiological factors; treatment outcomes; and mortality rates. Results: Thirty-eight patients (24 males, 14 females) were evaluated; mean age was 60.2 ± 13.2 years. While 76.3% (n = 29) of these patients recovered with treatment, the total mortality rate was 23.7% (n = 9). The most common cause of the FG and comorbidity were anorectal diseases (n = 22; 57.9%) and type 2 diabetes mellitus (n = 21; 55.3%), respectively. Female gender, septic shock, necrosis, abdominal wall and lumbar region involvement, chronic renal failure, FG development secondary to postoperative complications and ostomy rates were higher in non-survivors. There were no significant differences between the two groups regarding leukocyte count at first presentation, number of debridement, dressing methods, reconstruction methods, and length of hospital stay. Conclusions: Female gender, presence of septic shock and necrosis on physical examination, involvement of the abdominal wall and lumbar region in addition to the perianal region, chronic renal failure, disease secondary to postoperative complications and the necessity of ostomy play an important role in mortality.

Fournier's Gangrene in an Older Patient

Fournier's Gangrene in an Older Patient

Sodium glucose-linked transport protein 2 inhibitors: An overview of genitourinary and perioperative implications.

Sodium glucose-linked transport protein 2 inhibitors are relatively novel drugs, used for the treatment of type 2 diabetes mellitus. Their use since Pharmaceutical Benefits Schemeapproval in Australia has increased drastically, possibly due to the low risk of hypoglycemic events and their advertised cardiovascular mortality benefits. However, as with any novel drug, adverse effects regarding their use require medical practitioner awareness for optimal patient outcomes. This paper aims to cover the major urological implications, including those pertinent perioperatively, that concern this class of drugs. There is a clear risk of developing genital mycotic infections with the use of sodium glucose-linked transport protein 2 inhibitors, including serious infections such as Fournier's gangrene. Evidence for developing urinary tract infections has been mixed. Sodium glucose-linked transport protein 2 inhibitor-induced lower urinary tract symptoms may have impacts on quality of life via pollakiuria and nocturia, of which there are increased reports. Perioperative use increases the risk of euglycemic diabetic ketoacidosis. It is recommended that sodium glucose-linked transport protein 2 inhibitors be ceased perioperatively.

Assessment of the Prognostic Effect of Blood Urea Nitrogen to Serum Albumin Ratio in Patients with Fournier's Gangrene in a Referral Center.

To assess the prognostic effect of blood urea nitrogen to serum albumin ratio in patients with Fournier's gangrene (FG) in a referral center in order to reduce the mortality of FG patients. Patients with FG were admitted and enrolled consecutively in this study from March 2008 to April 2020. Statistical analysis was done to evaluate the differences between the two groups and to identify the best cutoff value to predict mortality and the need for intensive care. Of all 114 patients, 46 patients (40.35%) died in the course of hospitalization and 40 entered the study. No variable manifested a notable difference except for the BUN to albumin ratio, which was significantly different (P-value = 0.045). The ratio of BUN to albumin was not associated with any other variables and was independently a predictor of death in FG patients. The ratio of BUN to albumin was significantly different among deceased and survived patients with FG. Therefore, more studies with a larger sample size are still needed to access this parameter properly.

OUR EXPERIENCE IN DIAGNOSIS AND TREATMENT OF NECROTIZING FASCIITIS

Background: Necrotizing fasciitis (NF) is a severe, relatively rare and potentially deadly infection, which is usually caused by one or two pathogenic microorganisms. The target areas that are affected are the skin and the subcutaneous tissues of the lower and the upper limbs, the scrotum, the perineal region (Fournier gangrene) and the abdominal wall. The early diagnosis and aggressive surgical treatment are of great importance for the outcome of this potentially lethal disease. 
 Methods: Eleven patients with diagnosis of NF had been treated in the Clinic of Plastic and Reconstructive surgery of St. George Hospital, Plovdiv for a five-year period (2013-2018). Based on the demographic, clinical and laboratory data the presurgical, the following surgical treatment, and the postsurgical management were analyzed.
 Results: The mean age of the patients was 58.7 years (median: 56 years, range 37–87 years) and 75% were men. Old age (above 65 years) and female gender correlated significantly with lethality. Most often the regions affected were the perineum and the scrotum (46.8%), followed by lower limbs (35.5%), upper limbs and abdominal wall (8.1%). Diabetes mellitus, oncologic diseases, alcohol addiction and chronic hepatic and renal diseases were found to be predisposing factors for development of NF. We started treatment with broad spectrum antibiotics, early and vigorous drainage and meticulous debridement with wide excision of the damaged tissues. Vacuum therapy was applied as part of the treatment of the defects. It allowed continuous wound cleaning and accelerated formation of granulation tissue, followed by definite closure of the defect.
 Conclusion: The diagnosis of NF needs adequate proceedings and treatment of the cases among surgeons as its clinical presentation is unspecific. The prompt surgical debridement and excision is the mainstay in the treatment of all patients and repeated surgical excisions are required. Plastic surgery is an undeniable stage in the complex treatment of NF regarding the large size of the wound and necessity of definite closure of the soft tissue defects.