Fournier's Gangrene: Conventional Dressings versus Dressings with Dakin's Solution

Abstract

Purpose. Fournier's gangrene is a fulminant and destructive inflammation of the scrotum, penis, and perineum. The objective of this study was to compare 2 different approaches to wound management after aggressive surgical debridement. Methods. Data from 14 patients with Fournier's gangrene were retrospectively collected (2005–2011). Once the patients were stabilized following surgery, they were treated with either daily antiseptic (povidone iodine) dressings (group I, n = 6) or dressings with dakin's solution (sodium hypochloride) (group II, n = 8). Results. The mean age of the patients was 68.2 ± 7.8 (55–75) years in group I and 66.9 ± 10.2 (51–79) years in group II. Length of hospital stay was 13 ± 3.5 (7–16) days in group I and 8.9 ± 3.0 (4–12) days in group II (P < 0.05). The number and rate of mortality was 1/6 (16.7%) in group I, and 1/8 (12.5%) in group II. Conclusions. The hospitalization time can be reduced with the use of dakin's solution for the dressings in the treatment of FG. Also, dressings with dakin's solution seems to have favorable effects on morbidity and mortality. Consequently dakin's solution may alter the treatment of this disastrous disease by reducing cost, morbidity and mortality.

Fournier’s Gangrene: Current Practices

“…Additionally, this concentration had been proven to be not only bactericidal but also nontoxic to host tissues. In a study by Altunoluk et al [44] it was shown that Dakin solution dressing reduced hospital stay morbidity and mortality. Application is justified when hydrogen peroxide is used in the correct circumstances, but precautions should be taken when used in closed spaces or under pressure, where liberated oxygen cannot escape, and dangerous side effects are described as blood oxygen embolism.…”

Dakin's solution in the treatment of severe diabetic foot infections

“…Some entities have strongly discouraged its use in wound care, especially because of its presumed cytotoxicity to healthy tissues, an observation mostly seen in laboratorial investigations. Nevertheless, this debatable yet relevant concern has not been definitely substantiated by in vivo studies and has especially not been significantly observed in real‐world clinical practice, where several successful reports regarding the medical use of DS have been published . Extremely inflammatory and infected human wounds create a dynamic complex environment that is difficult to replicate with precision in the laboratory, which at least partially justifies the disagreement in the laboratory and real‐world clinical practice with regard to observed cytotoxicity.…”

“…Nevertheless, this debatable yet relevant concern has not been definitely substantiated by in vivo studies 17 and has especially not been significantly observed in real-world clinical practice, where several successful reports regarding the medical use of DS have been published. [8][9][10][11][12] Extremely inflammatory and infected human wounds create a dynamic complex environment that is difficult to replicate with precision in the laboratory, which at least partially justifies the disagreement in the laboratory and real-world clinical practice with regard to observed cytotoxicity. For example, open wounds contain a myriad of components (serum, pus, necrotic debris) that probably mitigate the potential toxicity of DS.…”

“…Diluted sodium hypochlorite, mostly known as Dakin's solution (DS), is a topical antiseptic first introduced to address World War I battle wounds . Its time‐honoured effectiveness, low cost, and wide availability have kept the solution in use to manage infected wounds . Nevertheless, concerns regarding its cytotoxicity and disputes over its effectiveness, coupled with dearth of evidence beyond limited clinical reports, led to several recommendations for its dismissal from the modern wound care armamentarium .…”

“…7 Its timehonoured effectiveness, low cost, and wide availability have kept the solution in use to manage infected wounds. [8][9][10][11][12] Nevertheless, concerns regarding its cytotoxicity and disputes over its effectiveness, coupled with dearth of evidence beyond limited clinical reports, led to several recommendations for its dismissal from the modern wound care armamentarium. 13 Whether this concern is valid in real-word practice remains debatable.…”