Alcoholism, diabetes mellitus, and immuno-suppression are the most likely underlying risk factor. Necrotizing fasciitis of the male genitalia involves Colles' fascia, dartos fascia, and the adjacent subcutaneous fat and spreads along superficial fascial planes. Symptoms consist of the acute onset of painful swelling of the penis or scrotum, fever, chills, and malaise. Painful induration, swelling, edema, blistering, and desquamation are noted. Palpable crepitus is usually very notable.
Management is operative with immediate and repetitive surgical debridements as needed.
Fluid resuscitation and multi-drug antibacterial therapy with activity against bacteria is begun after blood and urine specimens are obtained for culture. Hyperbaric oxygen therapy may be beneficial. Replacement of debrided skin with a variety of reconstructive plastic procedures must be accomplished as necessary. Plastic surgery consultation and management is recommended for most of these patients. In Gillenwater JY, Grayhack JT, Howards SS, et al.