Negative pressure wound therapy and split thickness skin graft aided in the healing of extensive perineum necrotizing fasciitis without faecal diversion: a case report

Abstract

BackgroundPerineum necrotizing fasciitis, also known as Fournier gangrene (FG), is a rare but highly mortal infectious necrotizing fasciitis with or without involvement of the underlying muscle. Evidence exists that negative pressure wound therapy (NPWT) combined with a split thickness skin graft (STSG) can help to heal wounds with FG. However, when the wound spreads to the anal area, it can easily be contaminated by faeces, causing a more extensive wounds; thus, faecal diversion is considered. Here, we report a case of extensive perineum necrotizing fasciitis that spread to near the anus; NPWT combined with STSGs was used to help heal the wound without faecal diversion.Case presentationA 47-year-old male patient was admitted with extensive perineum fascia necrosis caused by Pseudomonas aeruginosa that rapidly spread to near the anus. After comprehensive therapy completed wound bed preparation, STSGs from the scalp were grafted to the wound, and NPWT was applied to improve STSGs survival and seal the anus without faecal diversion.After treatment, graft take was 95%, and the exposed testicular and residual wounds were repaired with a local skin flap. At discharge, the wound had decreased to two pea-sized areas. The patient received conventional moist gauze therapy to close the residual wound at the local hospital. A follow-up by telephone 1 month later showed that both wounds had healed and that the patient was satisfied with the outcome.ConclusionNPWT use combined with STSGs to cover the whole wound and the anus without faecal diversion is a safe and effective method to help with wound healing and avoid contamination with excrement.

Negative Pressure Wound Therapy for the Treatment of Fournier’s Gangrene: A Rare Case with Rectal Fistula and Systematic Review of the Literature

“…Chang et al [ 34 ] (2018) reviewed a case series of 13 patients affected by FG treated with NPWT after surgical debridement without reconstructive procedures. Tian et al [ 35 ] (2018) described a case of FG of the perineum, successfully treated. The NPWT was applied to a split-thickness skin graft to improve graft survival and cover the anus to prevent fecal contamination avoiding a fecal diversion system.…”

Fascitis necrotizante perineal

“…Es importante el realizar cambios en la terapia empírica basado en los cambios de la flora bacteriana y la relación entre factores pronósticos pobres, mortalidad y patógenas causales de GF (15). La colostomía se realiza de manera rutinaria en heridas cercanas al área perineal, en un intento de evitar la contaminación de la herida con descarga fecal y evitar extensión de la herida y pérdida de injertos en casos necesarios (1,16). En años recientes, la terapia con presión negativa (NPWT por sus siglas en inglés) se ha utilizado para acelerar la curación de las heridas fisiológicamente (17.18).…”

Oxigenoterapia hiperbárica ou terapia com pressão negativa: qual a melhor forma de tratamento para pacientes com Síndrome de Fournier? Uma revisão sistemática da literatura

“…A Síndrome de Fournier consiste em uma patologia infecciosa grave de caráter degenerativo que afeta rápida e progressivamente a pele, tecido subcutâneo e fáscia superficial da região genital e áreas adjacentes, podendo estender-se também por toda a parede abdominal anterior. Essa doença se inicia com uma endarterite obliterante que gera um alto comprometimento dos vasos sanguíneos da região devido hipóxia, isquemia e trombose vascular, o que consequentemente leva à necrose tecidual e múltiplas disfunções metabólicas capazes de gerar efeitos locais e sistêmicos (Tian et al, 2018;Reis Filho, 2020;Cardoso & Féres, 2007).…”