Can be from direct inoculation/skin breakdown/trauma or hematogenous seeding
Poly-microbial (aerobes and anaerobes) tends to occur in elderly/compromised; single organism (grp A strep, staph, vibrio, aeromonas, other) in any age
In GU/Perineum area called Fourniers
Risk Factors
Bacteremia
Assoc w/older age, diabetes, vascular disease, impaired immunity or perfusion
Trauma (clostridium), tissue injury, or other point of entry for organisms
Symptoms
Acute pain
Swelling
Fever
Toxic appearing
Often rapidly progressive
Physical Exam Findings
Typically abnl vital signs consistent w/severe illness
Edema, redness, bulla, dark discoloration/necrosis
Initial findings can be subtle; more profound as dz progresses
Sometimes crepitus from gas formation
Intraoperative findings: "dishwater" fluid (gray/watery), liquefied fat, non-viable tissue (sub-cu, fascia, muscle), easy to pass finger along fascial planes