**14. Fournier gangrene**

Gas gangrene is a rapidly progressive infection caused by *Clostridium perfringens*, *Clostridium septicum*, *Clostridium histolyticum*, or *Clostridium novyi*. Severe penetrating trauma or crush injuries associated with interruption of the blood supply are the usual predisposing factors. *C. perfringens* and *C. novyi* infections have recently been described among heroin abusers following intracutaneous injection of black tar heroin. *C. septicum*, a more aerotolerant *Clostridium* species, may cause spontaneous gas gangrene in patients with colonic lesions (such as those due to diverticular disease), adenocarcinoma, or neutropenia.

This type of inflammation of the soft tissue grunt includes scrotum and penis or vagina and can have a malicious or explosive beginning [75]. The average age of onset is 50 years. Most of the patients suffer from a significant illness, especially diabetes, but 20% of them will not have a clear reason. Most patients initially have an infection around the anus or retroperitoneal spread on aircraft along the fascia to the genitals. Inflammation of the urinary tract, the most common in the event of a narrowing of the urethra, and includes glands around the urethra and extends to the penis and scrotum; or previous trauma to the genital area, allowing the arrival of living organisms to the tissues under the skin.

Infection can start insidious with a separate area of necrosis in the perineum, which is rapidly advancing within 1–2 days with the progress of skin necrosis. In the beginning, it tends to cause surface gangrene, and is limited to the skin and subcutaneous tissue, and extends to the base of the scrotum. Usually save the testicles, glans penis, and the spermatic cord, because they contain a separate blood source. Infection may extend to the perineum and the anterior abdominal wall through the fascia aircraft.

Most of the cases caused by mixed aerobic and anaerobic plants. Often there are types of *Staphylococcus aureus* bacteria *Pseudomonas*, usually in a mixed culture, but in some cases, be *Staphylococcus aureus* is the only pathogen. False is another common object in the mixed culture. As with other infections dead, is the rapid surgical exploration of aggressive and appropriate purification necessary to remove all the dead tissue, while avoiding the deeper structures when possible.

## **15. Clostridial myonecrosis**

Cause gas gangrene *Clostridium* (e.g., muscular muscle necrosis) significantly from *C. perfringens* and *C. novyi* and *C. histolyticum* and *C. septicum*. *C. perfringens* is the most common cause of gas gangrene associated with shocks. Severe pain increasingly begins at the site of infection after 24 h of infection is the first symptom of reliable. The skin may be pale at first, but quickly changed to bronze and then to the red color purple. The area becomes infected tense and smooth, show fluid-filled bubbles blue reddish. There is gas in the tissue, which is detected as crepitus or on the basis of imaging studies, globally present at this late stage. Systemic signs of toxicity, including irregular heartbeats, fever, sweating, develop rapidly, followed by shock and the failure of multiple members.

Both painful gas gangrene and spontaneous are destructive infection requiring accurate intensive care, and support measures, and aggressive surgical revision, and appropriate antibiotics. The role of oxygen therapy high pressure is still unclear. Altemeier and Fullen [76]. It has been reported significant reduction in the mortality rate among patients with gas gangrene using penicillin and tetracycline in addition to aggressive surgery in the absence of high-pressure oxygen. Treatment of experimental gas gangrene proved that tetracycline and clindamycin and chloramphenicol were more effective than penicillin or high-pressure oxygen treatment [77].

#### **16. Clinical manifestations**

Abscess clear zones of erythema, edema, and warmth. Evolve as a result of bacteria entering through the breakthroughs in the skin barrier [78]. You can be seen Petechiae and/or bleeding in the skin erythema, and can surface bubbles occur. Fever and other systemic manifestations of infection may also be present. Cysts are always one-sided almost, lower limbs are the most common sites of involvement; bilateral engagement should consider quickly in alternative causes [79].

Cysts deep dermis and subcutaneous fat include; reddish include the upper and lymph dermis surface. Cysts with or without purulent may appear. Erysipelas is grainy [80]. It tends patients with cysts or cellulitis to get more comfortable with the development cycle of topical symptoms over a few days [81].

Patients suffering from erysipelas usually suffer from the emergence of severe symptoms with systemic manifestations, including fever, chills, feeling very upset and headache; these can precede the onset of signs and symptoms of local infections from minutes to hours. In erysipelas, there is a clear demarcation between the involved and associated tissues. There may be raised or erythematous border with central clearing. Classic descriptions of the red leaf notes "butterfly" face involvement. The involvement of the ear (ear tag in Milian) is a distinctive feature of Oryeceblas, because this area does not contain deeper tissues of the skin [82].

Additional features of the abscesses and lymphatic vessels Oristepelas inflammation and enlargement of the regional lymph nodes. Edema surrounding Bbesellat hair may lead to variation in the skin, which creates showing little strength orange peel ("peau d'orange"). This can be seen vesicles bubbles and akimats or Alnchat. Can bleeding skin in the case of a significant inflammation of the skin. Inflammation of the cellular tissue that causes injury and inflammation Alglazi Algrgreeni is an unusual manifestation of inflammation due to cellular Alclaustradia and other anaerobes. It should be the acute manifestations of systemic toxicity with the rapid investigation of additional sources underlying infection [83].
