Erythema in the shaft skin should raise the concern for spreading wound infection and impending faciitis if not treated promptly. Normal neonates do not show bandemia. Admission for observation and broad spectrum antibiotics is warranted. However, there is no consensus on whether the plastibell should be removed at this point. The plastibell is an external device and it is not unreasonable to leave it on if the circumcision is only recently performed.
Surgical intervention is indicated when faciitis is suspected.
High index of suspicion, prompt diagnosis, immediate fluid resuscitation and institution of broad spectrum antibiotics followed by debridement is the key successful treatment of Fournier's gangrene. The disease is extremely lethal. Faciitis caused by streptococcal infection and Chicken pox on the face has been successfully treated by raising skin flaps for subcutaneous drainage without excision. In this way, skin can be preserved and cosmesis preserved. At present this technique should not be extrapolate to use in Fournier's gangrene which is polymicrobial in nature.