Fournier’s gangrene is a fast-progressing necrotizing infection that affects the external genitalia and frequently extends to the perineum [1].

Ischemic gangrene of the penis is extremely rare due to its rich blood supply but carries high morbidity and mortality due to the substantial risk of sepsis [2].

Identifying the exact portal of entry is often difficult. Fournier’s gangrene has been linked to several risk factors, including advanced age, diabetes, alcoholism, immunosuppression (e.g., HIV), and obesity. Early symptoms are often nonspecific, resembling cellulitis with erythema and induration. As the condition progresses, necrosis and the characteristic signs of Fournier’s gangrene develop, with patients frequently presenting to the hospital in severe or septic states [1]. The infection typically has a polymicrobial origin, with Group A streptococcus being the most commonly detected organism, though the underlying cause remains poorly understood [3].

Various imaging techniques help assess the presence of air and the extent of infection in Fournier’s Gangrene (FG). Standard radiography is a quick, effective tool as 90% of FG cases show subcutaneous emphysema, while ultrasonography can detect subcutaneous gas as “dirty” acoustic shadowing. Computed Tomography (CT) is the most specific imaging modality for infection extent, aiding surgical planning, while Magnetic Resonance Imaging (MRI) is reserved for unclear cases but should not delay surgery due to FG’s rapid progression [4]. Neither patient underwent imaging, given the advanced stage of the disease.

Managing Fournier’s Gangrene (FG) is challenging due to its nonspecific symptoms and rapid necrotic progression. Treatment involves hemodynamic stabilization, broad-spectrum antibiotics, and urgent surgical debridement to remove all necrotic tissue until viable tissue is reached. Prompt removal of necrotic tissue is essential to prevent infection spread, though debridement often results in significant tissue deficits. A retrospective study of 72 FG patients linked delayed debridement to significantly higher mortality, emphasizing the importance of timely and extensive intervention for improved outcomes [4].

Gangrene can be classified into two types: dry gangrene and wet gangrene, the latter characterized by secondary infection. Dry gangrene is typically managed conservatively, whereas partial or total penectomy is indicated for wet gangrene with tissue infection. The use of a tourniquet during surgery is contraindicated to avoid increasing ischemic areas, a precaution that was observed during our procedure [5,6].

Following surgical debridement, effective local wound care is essential and often involves techniques such as vacuum-assisted closure (VAC) devices or wet-to-dry dressings. Once granulation tissue forms, patients typically require reconstructive surgery to provide adequate tissue coverage for the affected area.