Debridement-Fourniers Disease

Fourniers Gangrene
A type of necrotizing fasciitis or gangrene usually
affecting the perineum.
Commonly seen in elderly men.
With diabetes, alcoholics, or those who are
immune compromised.

Clinical Manifestations:
Fever
General discomfort (malaise)
Moderate to severe pain and swelling in the
genital and anal areas (perineal)
Rankness and foul smell
Rubbing the affected area
In severe cases, the death of tissues extend

Causes:
Bacteria
Fungi
Viruses

Debribement
is the medical removal of dead,
damaged, or infected tissue to improve
the healing potential of the remaining
healthy tissue.

Purpose:
Debridement is used to clean dead
and contaminated material from your
wound to aid in healing.

The procedure is most often done for the following reasons:

To remove tissue contaminated by bacteria,

foreign tissue, dead cells, or crusting
To create a neat wound edge to decrease scarring
To aid in the healing of very severe burns or
pressure sores (decubitus ulcers)
To get a sample of tissue for testing and
diagnosis

Types:
Removal may be:
Surgical
Mechanical
Chemical
Autolytic (self-digestion)
By maggot therapy, where certain species of live
maggots selectively eat only necrotic tissue.

Instruments:

Nursing Responsibilities

PREOPERATIVE CARE
Discuss the impending surgery, the clients
concerns regarding surgery and its risks, and
what steps will be taken if surgery is ineffective.
Open discussion and active listening are
important means of gaining the clients trust and
encouraging the client to express concerns about
the outcome of the surgery.

 Surgery is frequently performed when 36 to 48

hours of antimicrobial therapy yields no
improvement and when prolonged bacteremia
and evidence of an abscess formation are
present. The periosteum is excised, allowing
access to the purulent material in the infected
area. If pus is not apparent, several holes may be
drilled into the bone. In some cases, irrigation
tubes are inserted and connected to an elaborate
system for postoperative antimicrobial therapy.

 Clients may need extensive antimicrobial

treatment postoperatively if an irrigation system
is surgically implanted. Before the procedure,
explain to the client that bed rest and an
extended period of treatment in the hospital are
imperative.
Clients who understand the events that may
occur postoperatively may be more accepting of
the required restrictions.

INTRAOPERATIVE CARE
Position patient with good ear down near edge of
bed closest to surgeon.
Ensure the proper room temperature, humidity
and lighting.
Make certain the equipments are safely
functioning.
Ensure that supplies and materials are available
for use during surgical procedures.

 Monitor the patient throughout the operative

procedure to ensure the persons safety and wellbeing.
Assists the surgeon and assistant during the
surgical procedure by anticipating the required
instruments, sponges, drains and other
equipment.
Keeps track of the time the patient is under
anesthesia and the time the wound is open.

POSTOPERATIVE CARE
Provide meticulous care of the dressing and/or
irrigation setup.
Frequently, the irrigation tubes are connected to
a 3-way stopcock, which allows irrigation and
drainage of the debrided area without separating
the tube from the collection device.
Nurses need to be extremely cautious and
adhere to strict sterile technique.

 Assess the client for manifestations of further

infection.
Although the client will receive antimicrobial
agents.
Assess the client continually for sudden spikes in
temperature, pain at the involved site, and other
indications of superinfection.

Here are a few suggestions to help you reduce your risk of developing gangrene:

Care for your diabetes

If you have diabetes, make sure you examine
your hands and feet daily for cuts, sores and
signs of infection, such as redness, swelling or
drainage. Ask your doctor to examine your
hands and feet at least once a year.

 Lose weight
Excess pounds not only put you at risk of
diabetes but also place pressure on your arteries,
constricting blood flow and putting you at risk of
infection and slow wound healing.

 Don't use tobacco

The chronic use of tobacco products can
damage your blood vessels.
Help prevent infections
Wash any open wounds with a mild soap and
water and try to keep them clean and dry until
they heal.

 Watch out when the temperature drops

Frostbitten skin can lead to gangrene because
frostbite reduces blood circulation in an affected
area. If you notice that any area of your skin has
become pale, hard, cold and numb after
prolonged exposure to cold temperatures, call
your doctor.