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

Abstract

Fournier’s gangrene (FG) is a Necrotizing Soft Tissue Infection (NSTI) of the perineal region characterized by high morbidity and mortality even if appropriately treated. The main treatment strategies are surgical debridement, broad-spectrum antibiotics, hyperbaric oxygen therapy, NPWT (Negative Pressure Wound Therapy), and plastic surgery reconstruction. We present the case of a 50-year-old woman with an NSTI of the abdomen, pelvis, and perineal region associated with a rectal fistula referred to our department. After surgical debridement and a diverting blow-out colostomy, an NPWT system composed of two sponges connected by a bridge through a rectal fistula was performed. Our target was to obtain healing in a lateral-to-medial direction instead of depth-to-surface to prevent the enlargement of the rectal fistula, promoting granulation tissue growth towards the rectum. This eso-endo-NPWT technique allowed for the primary suture of the perineal wounds bilaterally, simultaneously treating the rectal fistula and the perineum lesions. A systematic review of the literature underlines the spreading of NPWT and its effects.

Principles of dressing and debridement in modern rural surgery: experience of a case of Fournier’s gangrene

“…randomized controlled trials are necessary to support the effectiveness of NPWT. 10 The study conducted by Agwu et al concluded that in resource-constraint setting, prompt and adequate resuscitation, aggressive debridement, use of hypertonic saline bath and appropriate broad-spectrum antibiotics give favourable outcome. 11 Another study concluded that treatment is started with fluid resuscitation, broad-spectrum antibiotics and aggressive surgical debridement.…”

Development of Fournier’s gangrene after chemotherapy for the recurrence of testicular cancer despite the absence of anorectal lesions: A case report

“…Negative pressure wound therapy can remove tissue exudate, reduce local edema, enhance neovascularization, and improve the tissue's natural self-healing. [43,44] Conversely, hyperbaric oxygen therapy improves tissue perfusion, promotes angiogenesis and fibroblast proliferation, and increases collagen synthesis and oxygen levels in tissues. [45] Four major questions can be raised in this case.…”