What is the role of biopsy in the workup of Fournier gangrene?

Updated: Jun 03, 2021
  • Author: Vernon M Pais, Jr, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

An incisional biopsy at the time of surgical debridement allows pathological distinction of Fournier gangrene (ie, necrotizing infection) from severe cellulitis. The former would benefit from excisional debridement, while the latter rarely requires surgical excision.

The biopsy sample should be taken from the point of maximal tenderness, and it should include skin and superficial and deep fascia. This sample may be sent for frozen-section analysis to assess for fascial necrosis. Early fascial involvement may appear as edematous fascia on gross inspection but may appear as frank necrosis on microscopic analysis.


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