Nonsurgical faecal diversion in the management of severe perianal sepsis: a retrospective evaluation of the flexible faecal management system

Goh, Minghui; Chew, Min‐Hoe; Au-Yong, Phui-Sze Angie; Ong, Choo-Eng; Tang, Choong Leong

doi:10.11622/smedj.2014176

Cited by 14 publications

(11 citation statements)

References 13 publications

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“…Apart from the fact that FG commonly develops in immunocompromised patients with comorbidities, such as diabetes mellitus and malignancy [4,13], even for immunocompetent patients, immune functions may be greatly reduced under stress; thus, the normal microflora of the human gut or skin, such as A. turicensis, may transform into pathogens. For patients without sphincter injury, not using surgical faecal diversion not only avoid wound contamination [14] but also can improve the prognosis of FG [15] as well as the patients' long-term quality of life. In this case, based on the necrotic extent of the patient's perineum (with an intact anal sphincter and without defecation problems) and his preference, we chose NPWT instead of a preventive colostomy before skin grafting to accelerate the preparation of the wound bed without faecal contamination, and a clinical outcome was achieved.…”

Section: Discussionmentioning

confidence: 99%

A rare case of male Fournier’s gangrene with mixed Actinomyces turicensis infection

et al. 2022

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Background Fournier's gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions. The majority of FG is caused by polymicrobial organisms involving mixed aerobes and anaerobes but rarely reveals Actinomyces species. Case presentation We report a healthy 67-year-old Asian male who presented with rapidly progressive painful swelling of the scrotum. Clinically diagnosed with FG, the patient underwent an emergency radical debridement, followed by broad-spectrum antibiotics and negative pressure wound therapy. The identification of the causative microorganisms showed Actinomyces turicensis and the antibiotic treatment was adjusted accordingly. After wound bed preparation, we took split-thickness skin grafts to cover the scrotal wound. Active management to minimize faecal contamination was applied throughout the whole course of treatment and repair. The patient was satisfied with the outcome. This was an extremely rare case of A. turicensis as the main causative pathogen of FG. Conclusions FG due to Actinomyces species is rarely reported, but we should still consider this pathogenic microorganism that has long been neglected.

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Section: Discussionmentioning

confidence: 99%

A rare case of male Fournier’s gangrene with mixed Actinomyces turicensis infection

et al. 2022

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“… 20 Recently, the Flexi-Seal Fecal Management System (ConvaTec, Inc., Skillman, N.J.) has been reported to be suitable for short-term fecal diversion to prevent the fecal contamination of perineum wounds; this system is an alternative treatment choice to colostomy and avoids additional operation or colostomy complications. 21 – 23 Eleven of our patients underwent colostomy due to the severity of Fournier gangrene and extensive perineum involvement.…”

Section: Discussionmentioning

confidence: 99%

Suture Technique to Prevent Air Leakage during Negative-Pressure Wound Therapy in Fournier Gangrene

Chang

Chou

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:The use of negative-pressure wound therapy (NPWT) for Fournier gangrene management is well documented; however, it is difficult to fixate GranuFoam dressings and maintain an airtight seal over the perineum area. We developed a simple method to facilitate GranuFoam fixation and improve airtight sealing.Methods:The Fournier’s gangrene severity index (FGSI) score less than 9 was collected in from January 2015 to October 2016. All 13 patients underwent fasciotomy, and NPWT was applied directly on fasciotomy wounds after the debridement of infected tissue. Partial wound closure was performed, and a portion of GranuFoam was inserted to facilitate fixation. The seal check was converted to a 0–10 scale score that was recorded every 4 hours during NPWT. Patient profiles including medical history, FGSI, method of wound closure, and length of stay were collected in this study.Results:The median age of the patients was 62 (38–76) years. The mean FGSI score was 4.3 ± 3.1. The average duration of NPWT was 17.5 ± 11.5 days, and the average seal check score was 0.8 ± 0.5. No seal check alarms were noted during the study. Successful wound closure was achieved in all patients without using additional reconstruction methods such as skin grafting or muscle flap coverage.Conclusions:The present results suggest that partial wound-edge closure and in situ GranuFoam fixation improve the NPWT leaks in Fournier gangrene wounds. Furthermore, this method is simple to learn and can be useful in applying NPWT to anatomically difficult areas.

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“…Over the past few decades, many papers have discussed non-surgical faecal diversion methods such as Foley catheter attachment to the anus, rectal tube insertion, creation of faecal pouch, and stool management systems with or without balloons [1][2][3][4][5][6]. It has been shown that non-surgical faecal diverting systems have reduced the patient's duration of hospital stay, additional surgery requirements, and rate of complications [6].…”

Section: Discussionmentioning

confidence: 99%

“…Wound management around the perineal region is always a challenging task due to high risk of faecal contamination. Perineal wounds are commonly caused by severe infections such as necrotising fasciitis and Fournier's gangrene; pressure ulcers from long term immobilised patients; or burns [1][2][3][4][5][6]. The risk of infection due to faecal contamination can result in sepsis, graft failure, delayed wound healing or scar complications.…”

Section: Introductionmentioning

confidence: 99%

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A novel approach of non-surgical faecal diversion technique with stoma bag application: A case report

Chuang¹

2018

Int J Case Rep Images

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Introduction: Faecal diversion techniques are commonly used to avoid contamination of wounds in the perianal, gluteal, or upper thigh regions. Diversion may be achieved using operative or non-operative methods. Traditional non-operative methods may be less effective for patients with anal sphincter damage or dysfunction. Case Report: Our report discusses a novel faecal diversion technique in a 67-year old female with a gluteal abscess complicated by necrotising fasciitis, which effectively used a perianal stoma to prevent faecal contamination of her wound. Conclusion: This method was safe, inexpensive, and effective, and prevented the need of operative management. We feel this technique is valuable in preventing faecal wound contamination in individuals with anal sphincter damage or dysfunction.

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Nonsurgical faecal diversion in the management of severe perianal sepsis: a retrospective evaluation of the flexible faecal management system

Cited by 14 publications

References 13 publications

A rare case of male Fournier’s gangrene with mixed Actinomyces turicensis infection

A rare case of male Fournier’s gangrene with mixed Actinomyces turicensis infection

Suture Technique to Prevent Air Leakage during Negative-Pressure Wound Therapy in Fournier Gangrene

A novel approach of non-surgical faecal diversion technique with stoma bag application: A case report

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