Combining Flexi‐Seal and negative pressure wound therapy for wound management in Fournier's gangrene

Özkan, Ömer Faruk; Altýnlý, Ediz; Köksal, Neşet; Senger, Serkan; Çelik, Atilla

doi:10.1111/iwj.12103

Cited by 13 publications

(8 citation statements)

References 3 publications

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“…The bacteria that cause the destructive infection in Fournier's gangrene are usually a mixture of causative microorganisms of colorectal origin. The debrided region is usually near the anus, which is prone to faecal contamination . Hence, a faecal diversion is a considerable choice in the treatment of Fournier's gangrene.…”

Section: Discussionmentioning

confidence: 99%

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Fournier's gangrene current approaches

Özkan

Köksal

Altınlı

et al. 2014

International Wound Journal

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Fournier's gangrene is a rare but highly mortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fournier's gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41·6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomy was performed in six cases (50%), Flexi-Seal was used in two cases (16·6%). In four patients (33·4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33·4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fournier's gangrene is a safe dressing method. It promotes granulation formation. Flexi-Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi-Seal and NPWT) is an effective and comfortable method in the management of Fournier's gangrene in appropriate patients.

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Section: Discussionmentioning

confidence: 99%

“…In Fournier's gangrene, also, this system can successfully be used in an effort to achieve faecal diversion. This device not only protects the wound from faecal contamination it also avoids the complications of colostomy .…”

Section: Discussionmentioning

confidence: 99%

Fournier's gangrene current approaches

Özkan

Köksal

Altınlı

et al. 2014

International Wound Journal

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“…When the FG spreads to near the anus, faecal diversion has been considered for several patients [ 1 , 3 ] because the wound is vulnerable to contamination from excrement, which increases the wound extent and results in graft loss [ 6 ]. Second, the perineum is very mobile, and the shear stress to a skin graft prohibits healing and engraftment [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown that NPWT can secure STSGs and improve graft survival in the treatment of FG [ 5 ]. However, when the infection spreads to near the anus, the wound is prone to faecal contamination [ 1 , 6 ]. Few reports have described the use of NPWT combined with STSGs in the anus area while also considering faecal contamination.…”

Section: Introductionmentioning

confidence: 99%

Negative pressure wound therapy and split thickness skin graft aided in the healing of extensive perineum necrotizing fasciitis without faecal diversion: a case report

et al. 2018

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BackgroundPerineum necrotizing fasciitis, also known as Fournier gangrene (FG), is a rare but highly mortal infectious necrotizing fasciitis with or without involvement of the underlying muscle. Evidence exists that negative pressure wound therapy (NPWT) combined with a split thickness skin graft (STSG) can help to heal wounds with FG. However, when the wound spreads to the anal area, it can easily be contaminated by faeces, causing a more extensive wounds; thus, faecal diversion is considered. Here, we report a case of extensive perineum necrotizing fasciitis that spread to near the anus; NPWT combined with STSGs was used to help heal the wound without faecal diversion.Case presentationA 47-year-old male patient was admitted with extensive perineum fascia necrosis caused by Pseudomonas aeruginosa that rapidly spread to near the anus. After comprehensive therapy completed wound bed preparation, STSGs from the scalp were grafted to the wound, and NPWT was applied to improve STSGs survival and seal the anus without faecal diversion.After treatment, graft take was 95%, and the exposed testicular and residual wounds were repaired with a local skin flap. At discharge, the wound had decreased to two pea-sized areas. The patient received conventional moist gauze therapy to close the residual wound at the local hospital. A follow-up by telephone 1 month later showed that both wounds had healed and that the patient was satisfied with the outcome.ConclusionNPWT use combined with STSGs to cover the whole wound and the anus without faecal diversion is a safe and effective method to help with wound healing and avoid contamination with excrement.

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“…The debrided region is usually near the anus, which is prone to fecal contamination. 15 Czymek et al 16 compared data from 35 patients with FG. Twenty-eight of the 35 patients (80%) had polymicrobial infections.…”

Section: Discussionmentioning

confidence: 99%

Negative Pressure Wound Therapy Applied Before and After Split-Thickness Skin Graft Helps Healing of Fournier Gangrene

Xie

et al. 2015

Medicine

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Fournier gangrene is a rare but highly infectious disease characterized by fulminant necrotizing fasciitis involving the genital and perineal regions. Negative pressure wound therapy (NPWT; KCI USA Inc, San Antonio, TX) is a widely adopted technique in many clinical settings. Nevertheless, its application and effect in the treatment of Fournier gangrene are unclear.A 47-year-old male patient was admitted with an anal abscess followed by a spread of the infection to the scrotum, which was caused by Pseudomonas aeruginosa. NPWT was applied on the surface of the scrotal area and continued for 10 days. A split-thickness skin graft from the scalp was then grafted to the wound, after which, NPWT utilizing gauze sealed with an occlusive dressing and connected to a wall suction was employed for 7 days to secure the skin graft.At discharge, the percentage of the grafted skin alive on the scrotum was 98%. The wound beside the anus had decreased to 4 × 0.5 cm with a depth of 1 cm. Follow-up at the clinic 1 month later showed that both wounds had healed. The patient did not complain of any pain or bleeding, and was satisfied with the outcome.NPWT before and after split-thickness skin grafts is safe, well tolerated, and efficacious in the treatment of Fournier gangrene.

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Combining Flexi‐Seal and negative pressure wound therapy for wound management in Fournier's gangrene

Cited by 13 publications

References 3 publications

Fournier's gangrene current approaches

Fournier's gangrene current approaches

Negative pressure wound therapy and split thickness skin graft aided in the healing of extensive perineum necrotizing fasciitis without faecal diversion: a case report

Negative Pressure Wound Therapy Applied Before and After Split-Thickness Skin Graft Helps Healing of Fournier Gangrene

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