Vacuum-Assisted Closure for the Treatment of Fournier’s Gangrene

Abstract

Background: Fournier’s gangrene (FG) is a very aggressive necrotizing fasciitis involving subcutaneous fat and skin of scrotal and perineal regions. Vacuum-assisted closure (VAC) is a well-known method used to treat complex wounds. The authors for the first time enhance a multimodal strategy to treat the FG using VAC, reducing the number of surgical debridements, allowing a one-step surgical reconstruction with locoregional fasciocutaneous flap. Methods: Six patients with the diagnosis of FG were reviewed retrospectively at our institution. All patients were affected by very extensive FG. The FG Severity Index (FGSI) was used to evaluate the prognosis of the case at admission. Following the acute phase (24–48 h), VAC was used to achieve wound cleaning and prepare the area to a single-stage reconstruction with superomedial thigh flap. Hyperbaric oxygen therapy was also used before final reconstruction. Results: The average FGSI was 10.5, ranging from 8 to 12. All patients survived and were completely healed at the mean follow-up time of 9 months (range 3–30 months). Conclusions: VAC therapy is effective to clean and prepare the wounds, cutting off the fasciitis process and reducing the hospital stay and patient discomfort. Multidisciplinary treatment is mandatory during this devastating infection.

Fournier’s gangrene: A retrospective analysis of 25 patients

“…VAC enables more comfortable mobilization and reduces the duration of hospital stay. [4,12,[21][22][23] We performed VAC in addition to debridement in 64% of our patients. The mean duration of hospital stay was 26.43 days in our cohort, and the mean number of debridements performed was 2.81 in patients who underwent VAC.…”

Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier’s gangrene

“…However, VAC effectively converts an open wound into a temporarily closed and controlled environment an it is possible to obtain much cleaner wounds without exudate by draining stagnant fluid and the debris. These devices stimulate angiogenesis and lead to an improvement of nourishment and tissue formation and create a favorable environment for healing in wound beds (12). The length of hospitalization can be exacerbated by large tissue defects or sepsis-induced complications.…”

Fournier Gangrene: Our Approach and Patients

“…Hyperbaric oxygenation was not used, although it can be beneficial. There are reports that vacuum-assisted drainage can be helpful [36] . Nevertheless, a number of our patients either presented at a time when such a procedure was not available or the inflammation and necrosis were too advanced ( fig.…”