Comparison of Standard Open Wound Care and Vacuum-assisted Closure Therapy in Fournier’s Gangrene

Abstract

Amaç: Fornier gangreninin tedavisi, agresif yara debridmanı, geniş spektrumlu antibiyotik kullanımı, yara bakımı ve gerekirse tekrar debridman gerektirir. Çalışmamızın amacı Fornier gangrenli hastaların tedavisinde klasik yara bakımının ve vakum yardımlı kapama malzemelerinin karşılaştırılmasıdır. Gereç ve Yöntem: Çalışmaya Fornier gangreni nedeniyle cerrahi yapılan otuz üç hasta (29 erkek ve 4 kadın) dahil edildi. Veriler retrospektif olarak değerlendirildi. Hataların 23 tanesi (%69,7) Diyabet hastalığı vardı ve 20 hastada (%60) kötü hijyen mevcuttu. Hastalar debridman sonrası yara bakımına göre 2 gruba ayırıldı. On dört hastaya antibiyotikli pomad ile günde 2 kez standart yara pansumanı yapıldı. On yedi hasta, 48-72 saatte bir değişen VAC tedavisi ile takip edildi. İki grubun verileri karşılaştırıldı. Bulgular: Hastaların 23 tanesi (%69,7) Diyabet hastalığı vardı ve 20 hastada (%60) kötü hijyen mevcuttu. Klasik pansuman ile takip edilen hastalarda tekrar debridman oranları VAC ile takip edilen hastalara göre istatistiksel olarak fazlaydı (p=0,016). Mortalite oranları, hastanede yatış süreleri ve Öz Objective: Management of Fournier's gangrene (FG) includes large wound debridement, broad-spectrum antibiotic, wound care and re-debridement if necessary. The aim of our study was to compare standard open wound care and vacuum-assisted closure (VAC) therapy in patients with FG. Materials and Methods: Thirty-three patients (29 males and 4 females) who underwent surgery for FG were enrolled in the present study. The data was evaluated retrospectively. The patients were divided into two groups according to wound care after large wound debridement. Standard open wound care with antibiotic pomade was performed twice a day in 14 patients and VAC therapy was performed every 48-72 hours in 17 patients. The data of the two groups were compared. Results: Twenty-three (69.7%) patients had Diabetes Mellitus and 20 patients (60%) had poor hygiene. The re-debridement rate in patients who received standard open wound care was statistically higher than in those who underwent VAC therapy (p=0.016). There were no statistically significant differences in mortality rate, length of hospital stay and need for reconstruction between the groups. When the data were analyzed, no statistically significant difference was found in FG Severity index score, length of hospital stay and mortality rate. However, the relationship between mortality rate and location of lesion was statistically significant (p=0.03). Four patients died, 3 (75%) due to wide necrotizing fasciitis extending to the abdominal wall. Conclusion: The present study showed that the technique used for wound care did not influence mortality, need for reconstruction and length of hospital stay. The only advantage of VAC therapy was decreased re-debridement rate in patients with FG.

Treatment optimization of patients with epithelial coccygeal passage complicated by an abscess

“…Самый простой метод хирургического лечения -разрез и дренирование, в большинстве случаев используемый при нагноении ЭКХ, избавляет пациента лишь от симптомов острого воспаления и в последующем приводит к рецидиву заболевания у 60-80% больных [9]. При ведении операционной раны открытым путем, в том числе с использованием дополнительных методов физической обработки ран, например вакуумной терапии [10][11][12][13], снижается число рецидивов в послеоперационном периоде, но сопровождается увеличением времени и площади заживления раны, и как следствие, более длительной нетрудоспособностью пациентов, что крайне экономически невыгодно [14 -16].…”

Diagnose und zielgerichtete Therapie der Fournier-Gangrän mit septischem Verlauf: Vorstellung eines Behandlungsalgorithmus, Identifikation von Risikofaktoren, Betrachtung des Mikrobioms und Abgleich mit der Literatur

“…In der Literatur wird die Anwendung der VAC-Systeme bei Fournier-Gangrän kontrovers diskutiert. Während einige Autoren keine Vorteile bei der Dauer des Krankenhausaufenthaltes sowie der Überlebensraten sehen, akzentuieren andere Autoren deutliche Vorteile dieser Therapiemethode im Vergleich zur konventionellen offenen Wundbehandlung 51 . Assenza et al betonen, dass eine eingesetzte VAC-Therapie die Dauer der Hospitalisation, die Gesamtmortalität und den Wundschmerz der Patienten deutlich reduziert 52 .…”

“…Assenza et al betonen, dass eine eingesetzte VAC-Therapie die Dauer der Hospitalisation, die Gesamtmortalität und den Wundschmerz der Patienten deutlich reduziert 52 . Die meisten Autoren sind sich über die Vorteile der Unterdrucktherapie in Bezug auf die Reduktion der Anzahl der Débridements sowie auf die Zufriedenheit der Patienten einig 51 , 53 . Czymek et al detektierten eine Mortalitätsrate von 5,3% nach Einführung der VAC-Therapie 53 .…”