Fournier gangrene / necrotizing perineal infection — rapidly spreading erythema, dusky/black skin, crepitus, pain out of proportion, systemic signs — life-threatening surgical emergency: escalate/transfer on the sepsis pathway.

Perineal wound infection / sepsis — spreading erythema, purulence, fever, or systemic signs — escalate promptly.

Rapidly worsening breakdown — extensive denudement or a deepening wound — escalate for treatment/pressure-redistribution review.

Acute urinary/fecal obstruction contributing to breakdown — address the source and escalate (route to Continence).