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

Abstract

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.

Effects of vacuum sealing drainage to improve the therapeutic effect in patients with orthopedic trauma and to reduce post‑operative infection and lower‑limb deep venous thrombosis

“…Thus, a good microenvironment is provided for wound repair, which effectively prevents infection and promotes wound healing (12). The continuous suction of exudate during VSD treatment may obviate frequent dressing changes and reduce the patient's pain (13). In addition, a relatively sealed, clean and dry negative-pressure environment is formed after the wound is covered with the VSD dressing.…”

Fournier's Syndrome Recurrence

“…9 Treatment done with surgery associated with antibiotic therapy and surgical wound care, achieved the expected success, presenting the need for new approaches with debridement, fact corroborated by literature with successful results. 3,6,7,10 The present case is an example of how early diagnosis and correct management and support is of essential relevance, for the treatment of Fournier's Gangrene to have an appropriate outcome.…”

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

“…NPWT provided better-wound care and better patient satisfaction because of fewer dressing changes needed but was associated with longer length of stay and more debridements; this was explained by the greater extension and degree of infection in cases where NPWT was applied. 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.…”