Treatment of Fournier's Gangrene with Combination of Vacuum-Assisted Closure Therapy, Hyperbaric Oxygen Therapy, and Protective Colostomy

Abstract

<jats:p>Fournier's gangrene is a rare process which affects soft tissue in the genital and perirectal area. It can also progress to all different stages of sepsis, and abdominal compartment syndrome can be one of its complications. Two patients in septic shock due to Fournier gangrene were admitted to the Intensive Care Unit of Emergency Department. In both cases, infection started from the scrotum and the necrosis quickly involved genitals, perineal, and inguinal regions. Patients were treated with surgical debridement, protective colostomy, hyperbaric oxygen therapy, and broad-spectrum antibacterial chemotherapy. Vacuum-assisted closure (VAC) therapy was applied to the wound with the aim to clean, decontaminate, and avoid abdominal compartmental syndrome development. Both patients survived and were discharged from Intensive Care Unit after hyperbaric oxygen therapy cycles and abdominal closure.</jats:p>

Are neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as effective as Fournier's gangrene severity index for predicting the number of debridements in Fourner's gangrene?

“…[17] The spread of infection is along the fascial planes and is usually limited by the attachment of the Colles' fascia in the perineum. Deeper infection that extends below the fascial layers causing myonecrosis is not generally thought of as classical Fournier's gangrene, although it has been described.…”

“…VAC devices support the reduction of edema and can increase fibroblast migration and cell proliferation, improving clinical outcome. [2,4,17] In the current study, this technique was used in two cases. In addition, topical wound care agents, such as honey and hyperbaric oxygen therapy, are among more recent alternatives.…”

“…In addition, topical wound care agents, such as honey and hyperbaric oxygen therapy, are among more recent alternatives. [17] We have had no experience with honey or hyperbaric oxygen.…”

Using negative pressure therapy for improving skin graft taking on genital area defects following Fournier gangrene

“…In the literature to this end application of NPT for the patients with Fournier gangrene for 3-22 sessions has been reported in various publications. [20] In our study, after application of NPT for an average of 6.64 sessions, all defects became suitable for reconstruction using grafts, and none of our patients needed reconstruction with a flap. In one patient with large defects occupying gluteal region, penis, and scrotum, application of 12 sessions of NPT were required, and for the remaining 12 patients 4-8 sessions of NPT sufficed.…”

A rare case of Fournier gangrene presenting with surgical emphysema of right upper abdomen

“…Vacuum assisted closure has been studied in patients with Fournier gangrene following wound debridement and shown to minimise skin defect and speed-up the healing process [16,17]. Other methods studied in speeding up wound healing include hyperbaric oxygen therapy and enzymatic debridement using topical agents [13,17].…”