Life-Threatening Fournier’s Gangrene Treated by Colostomy and Vacuum Assisted Closure

Abstract

Fournier's gangrene is a necrotizing fasciitis encountered in the scrotal and perineal region which progresses rapidly to a life-threatening state. Treatment options are dependent on the origin of the disease and lesion extent and depth. We report our experience of a case of Fournier's gangrene treated by colostomy and vacuum assisted closure (VAC). A 66-year-old man visited our emergency room with swelling and pain of his left buttock. After wide debridement of the perianal area and left buttock, VAC was applied for continuous drainage and to accelerate granulation. In addition, colostomy was performed to prevent fecal contamination. Four weeks after second debridement (with VAC and colostomy), we performed split thickness skin graft and local flap to successfully cover the wounds. We suggest VAC after early debridement and as a bolster dressing after skin grafting in managing Fournier's gangrene. We also recommend that if fecal contamination is suspected during the application of VAC, colostomy should be performed at early stage.

Necrotizing Fasciitis on the Abdomen, Perineal Area and Thigh after Panperitonitis

“…Surgery is an important treatment for infection source control, the goal of which is to debride all necrotic tissue, leaving and exposing only viable tissue. In a previous study, to treat Fournier's gangrene with fecal contamination, colostomy was performed to resolve contamination, and defect sites were reconstructed by skin graft with vacuum assisted wound therapy [7]. In our case, we performed wound irrigation daily in the operating room.…”