Modern Perspectives on Fournier’s Gangrene: A Narrative Review of Surgical Advances, and Adjunctive Therapies

Fournier’s Gangrene (FG) is a rare but rapidly progressive necrotising fasciitis of the perineal, genital, and perianal areas, more commonly occurring in older males with comorbidities such as diabetes mellitus and immunosuppression. This narrative review aims to define variations in the clinical presentation of FG, given its broader impact, and to highlight unresolved diagnostic challenges due to its non-specific initial presentation and specific atypical presentations in females. Aetiopathogenesis involves polymicrobial aerobic and anaerobic organisms synergistically infiltrating along fascial planes. Emerging literature notes a rare association between FG and Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors. A definitive treatment remains urgent surgical intervention for debridement, broad-spectrum intravenous antibiotics, and intensive supportive care. There are advanced therapies that may improve patient outcomes, such as Vacuum-Assisted Closure (VAC), Hyperbaric Oxygen Therapy (HBOT), negative-pressure wound therapy, and novel options in reconstructive surgery. These include reconstruction using gracilis muscle flaps or super-thin Anterolateral Thigh (ALT) flaps to improve functional and aesthetic results. This narrative review shows the importance of heightened clinical suspicion, particularly in the more aggressive form of necrotising fasciitis, the need for multidisciplinary care, and the incorporation of techniques in surgical practice and adjunctive therapy that may improve surgical outcomes for patients with FG.