Rectal diversion without colostomy in Fournier’s gangrene

Estrada, Óscar; Martínez, Isabel Peral; Bas, Mustafa; Salvans, Sílvia; Hidalgo, Luis

doi:10.1007/s10151-009-0474-6

Cited by 28 publications

(16 citation statements)

References 13 publications

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“…It was originally designed for intensive care patients with a rectal tube that allows diversion of faecal matter from the rectum to a collector bag. In this way, it avoids faecal leakage, and thus keeps the wound clean . In Fournier's gangrene, also, this system can successfully be used in an effort to achieve faecal diversion.…”

Section: Discussionmentioning

confidence: 98%

Fournier's gangrene current approaches

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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: 98%

Fournier's gangrene current approaches

Özkan

Köksal

Altınlı

et al. 2014

International Wound Journal

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“…The device protects the wounds from fecal contamination and reduces the same way that a colostomy both the risk of skin breakdown and repeated inoculation with colonic flora. Estrada et al [42] showed that it was effective way for fecal diversion and forms an alternative to colostomy. It is recommended to explore the canal anal before placement of the catheter in order to avoid rectal injuries.…”

Section: Treatment and Managementmentioning

confidence: 99%

Fournier’s Gangrene: Current Practices

et al. 2012

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Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20–30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes.

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“…In the literature, there are few reported cases regarding the use of Flexi-Seal Faecal Management System in Fournier's gangrene. Our approach differs from previous cases (3,4), with the combination of Flexi-Seal and NPWT, as presented here. This helped us to achieve faster wound healing.…”

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confidence: 90%