Hyperbaric oxygen therapy in early phase Fournier's necrotizing fascitis

In 1883 the French venereologist Fournier reported on acute genital gangrene in young men, with rapid evolution and no clear etiology. It is now known that Fournier's gangrene is a necrotizing fascitis not exclusive to male subjects (in 14% of cases it occurs in female) due to polymicrobic infection, mainly anaerobic at the onset. The predisposing factors are: diabetes, alcohol abuse, immunodeficiency and chronic diseases, while promoting causes are among others, dermatosis of the genital area, digestive system diseases, lower urinary tract pathologies, urinary tract instrumentations, surgical procedures on the bowel. However in some 25% of cases no clear etiology can be evidenced. The usual treatment strategies employ wide spectrum antibiotics, surgical ablation of the necrotic tissue, drainage of abscesses, prednisone and Hyperbaric Oxygen Therapy (HOT). We have treated 2 patients affected by necrotizing fascitis with early HOT, assuming that oxygen administration would have a bactericidal activity, and this strategy gave satisfactory results, avoiding extensive necrosis and the need for surgical revision.