Comparison of Vacuum-assisted Closure and Conventional Dressing Treatment Modalities for Fournier’s Gangrene
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DOI:
https://doi.org/10.5152/eurjther.2020.20026Keywords:
Fournier’s gangrene, vacuum-assisted closure, debridementAbstract
Objective: The aims of this study were to evaluate the etiology and predisposing factors of patients with Fournier’s gangrene (FG) and to compare the results and efficacy of vacuum-assisted closure (VAC) treatment with conventional dressings and debridement method.
Methods: The data of 52 patients diagnosed with FG and treated at our clinic between January 2013 and October 2018 were analyzed. Patients diagnosed with FG based on physical examination findings and anamnesis were analyzed. Patients with VAC applied (Group I) and not applied (Group II) were analyzed for demographics, etiology, wound culture results, predisposing factors, FG severity index, visual analog scale (VAS) for pain, number of debridements, requirement for analgesia, colostomy, length of hospital stay, and complications.
Results: Group I included 37 patients treated with conventional daily dressings, and Group II included 15 patients who were treated with VAC. No significant difference was determined between the groups with respect to etiology, microorganism type, or predisposing factors. Length of hospital stay was similar in both groups. Statistically significant differences were observed between the groups with respect to the number of debridements, VAS values, mean number of daily dressings, and use of analgesia (P<0.001).
Conclusion: VAC treatment does not decrease treatment duration, but less pain is felt during dressing changes as fewer dressings are used. Patient tolerance to treatment is also improved. It may be considered that the use of VAC treatment in wound care for patients with FG could increase patients’ tolerance to treatment and quality of life.
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References
Fournier JA. Jean-Alfred Fournier 1832-1914. Gangrène foudroyante de la verge (overwhelming gangrene). Sem Med 1883. Dis Colon Rectum 1988; 31: 984-8.
Sorensen MD, Krieger JN. Fournier's Gangrene: Epidemiology and Outcomes in the General US Population. Urol Int 2016; 97: 249-59.
Eke N. Fournier's gangrene: a review of 1726 cases. Br J Surg 2000; 87: 718-28.
Chennamsetty A, Khourdaji I, Burks F, Killinger KA. Contemporary diagnosis and management of Fournier's gangrene. Ther Adv Urol 2015; 7: 203-15.
Hong KS, Yi HJ, Lee R-A, Kim KH, Chung SS. Prognostic factors and treatment outcomes for patients with Fournier's gangrene: a retrospective study. Int Wound J 2017; 14: 1352-8.
Wagner S, Greco F, Hoda MR, Kawan F, Heynemann H, Fornara P. Is intensive multimodality therapy the best treatment for fournier gangrene? Evaluation of clinical outcome and survival rate of 41 patients. Surg Infect (Larchmt) 2011; 12: 379-83.
Misiakos EP, Bagias G, Papadopoulos I, Danias N, Patapis P, Machairas N, et al. Early Diagnosis and Surgical Treatment for Necrotizing Fasciitis: A Multicenter Study. Front Surg 2017; 4: 5.
Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier's gangrene. J Urol 1995; 154: 89-92.
Czymek R, Schmidt A, Eckmann C, Bouchard R, Wulff B, Laubert T, et al. Fournier's gangrene: vacuum-assisted closure versus conventional dressings. Am J Surg 2009; 197: 168-76.
Ward L, Eisenson D, Fils J-L. Fournier's gangrene of the penis in a 12-year-old patient secondary to phimosis. R I Med J (2013) 2016; 99: 45-6.
Zgraj O, Paran S, O'Sullivan M, Quinn F. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene): a case report. J Med Case Rep 2011; 5: 576.
Hahn HM, Jeong KS, Park DH, Park MC, Lee IJ. Analysis of prognostic factors affecting poor outcomes in 41 cases of Fournier gangrene. Ann Surg Treat Res 2018; 95: 324-32.
Yücel M, Özpek A, Başak F, Kılıç A, Ünal E, Yüksekdağ S, et al. Fournier's gangrene: A retrospective analysis of 25 patients. Ulus Travma Acil Cerrahi Derg 2017; 23: 400-4.
Norton KS, Johnson LW, Perry T, Perry KH, Sehon JK, Zibari GB. Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment. Am Surg 2002; 68: 709-13.
Singh A, Ahmed K, Aydin A, Khan MS, Dasgupta P. Fournier's gangrene. A clinical review. Arch Ital Urol Androl 2016; 88: 157-64.
Li Y-D, Zhu W-F, Qiao J-J, Lin J-J. Enterostomy can decrease the mortality of patients with Fournier gangrene. World J Gastroenterol2014; 20: 7950-4.
Slater DN, Smith GT, Mundy K. Diabetes mellitus with ketoacidosis presenting as Fournier's gangrene. J R Soc Med 1982; 75: 530-2.
Lamb RC, Juler GL. Fournier's gangrene of the scrotum. A poorly defined syndrome or a misnomer? Arch Surg 1983; 118: 38-40.
Scott SD, Dawes RF, Tate JJ, Royle GT, Karran SJ. The practical management of Fournier's gangrene. Ann R Coll Surg Engl 1988; 70: 16- 20.
Ozkan OF, Koksal N, Altinli E, Celik A, Uzun MA, Cıkman O, et al. Fournier's gangrene current approaches. Int Wound J 2016; 13: 713- 6.
Fabian TS, Kaufman HJ, Lett ED, Thomas JB, Rawl DK, Lewis PL, et al. The evaluation of subatmospheric pressure and hyperbaric oxygen in ischemic full-thickness wound healing. Am Surg 2000; 66: 1136- 43.
Assenza M, Cozza V, Sacco E, Clementi I, Tarantino B, Passafiume F, et al. VAC (Vacuum Assisted Closure) treatment in Fournier's gangrene: personal experience and literature review. Clin Ter 2011; 162: e1-5.
Cuccia G, Mucciardi G, Morgia G, Stagno d'Alcontres F, Gali A, Cotrufo S, et al. Vacuum-assisted closure for the treatment of Fournier's gangrene. Urol Int 2009; 82: 426-31.
Silberstein J, Grabowski J, Parsons JK. Use of a Vacuum-Assisted Device for Fournier's Gangrene: A New Paradigm. Rev Urol 2008; 10: 76-80.
Yanaral F, Balci C, Ozgor F, Simsek A, Onuk O, Aydin M, et al. Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier's gangrene. Arch Ital Urol Androl. 2017; 89: 208-11.
Ozturk E, Ozguc H, Yilmazlar T. The use of vacuum assisted closure therapy in the management of Fournier's gangrene. Am J Surg 2009; 197: 660-665.
Driver VR, Eckert KA, Carter MJ, French MA. Cost-effectiveness of negative pressure wound therapy in patients with many comorbidities and severe wounds of various etiology. Wound Repair Regen 2016; 24: 1041-58.
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