# Fournier's gangrene



## KaylaRieken (Nov 15, 2017)

Please help me with this op note.

Careful inspection of the wound showed that there was started to be some skin color changes over the abscess and careful palpation did reveal fluctuant area beneath the skin. This was quite lateral to the scrotum. An incision was made about 7-8 cm in length and carried down to the abscess. A moderate amount of very purulent foul-smelling tissue typical of necrotizing fasciitis was found. The abscess cavity was then carefully explored and it did carry down towards the buttocks and up into the inguinal area. It did not appear to go into the peritoneum and did not appear to enter into the scrotum, but mainly quite lateral to the scrotum and towards the buttocks. I did explore the extent of the cavity and the wound was copiously irrigated and left open. 

The next day he goes back in for wound debridement. 

The wound was inspected. I did find another pocket that still had some necrotic liquefied tissue that was very foul smelling. This was opened up. Inspection for the rest of the wound showed much less necrotic area that initially. I did carry the debridement down to where it had basically vascularized tissue. The wound was carefully irrigated and no other pockets were found. The pocket did trace down towards the rectum, but _____ appear to stop short of the rectum. It did go up towards the inguinal canal, but did not go up into the peritoneum as best as we could tell. Wound did have its limits there. I did open up the wound farther inferiorly. The scrotum was still markedly enlarged with swelling, but dotes not appear crepitus and I think it just has reactive inflammation and the entire scrotum itself was not involved.


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