Mp35-08 clinical Characteristics Associated With Wound Closure in Patients With Fournier's Gangrene: A Single Tertiary Institution Experience

Abstract

INTRODUCTION AND OBJECTIVE: FG management is performed by either reconstructive urology (RU) or surgery/burn (SB) at our institution. Component separation closure (CSC) has become method by the RUs over split-thickness skin grafting (STSG), which is still favored by SB. The purpose of this study was to compare surgical management and outcomes between these cohorts and to determine patient and wound predictors for the need for split thickness skin grafting and post-operative wound morbidity.METHODS: Between 2009-19, 138 men underwent debridement for FG; 82 (59%) were managed with debridement alone (þ/wound vac (WV)), and 8 (6%) died w/in 72 hours, leaving 48 that underwent surgical reconstruction. Reconstruction was performed by RU (n[29) and BP (n[19). FG anatomical extent (AE) was categorized as none (0), <50% (1) and >50% (2) for the penis, scrotum, perineum and suprapubic region, with a total AE score that ranged from 1 (min) to 8 (max). CSC involves debridement of granulation tissue with a VER-SAJET, aggressive mobilization of skin flaps and involved spermatic cordsþ/-hydrocelectomy, with the goal of primary closure of all defects when a tension free anastomosis can be obtained and sexual/urinary compromise is not predicted. Closure over a drain is performed with 2-0 polygactin (deep) and 3-0 nylon interrupted for skin. Unclosed areas after CSC are treated with either STSG or secondary intentionþ/-WV (Figure 1). RESULTS: Cohort FG AE is depicted in Figure 2, with scrotum (n[44, 92%) and perineum (n[29, 60%) being most affected. STSG was utilized in 100% of cases closed by SB and 31% (9/29) closed by RU, though mean AE was higher in SB managed wounds versus RU (4.5 v 2.7, p[0.001). STSG use by RUs was predicted by site number with >50% loss (each site OR 4.1,p[0.0017) and total AE (each point OR 3.2,p[0.0156) controlling for age, BMI and days to closure. Minor and major (requiring intervention) wound morbidity was noted in 13 (27%) and 3 (6%), not predicted by RU/SB, AE or STSG use.CONCLUSIONS: CSC of FG wounds significantly decreases the need for STSG without increasing wound morbidity.