Vacuum-Assisted Treatment in Ournier Gangrene

Purpose: Fournier gangrene is a potentially morbid, polymicrobial infection-related disease with aggressive progression. Suitable antibiotherapy, aggressive surgery, recurrent dressing, and debridement are sufficient for Fournier gangrene treatment. However, owing to the extended duration of hospitalization and high mortality rates, there is still a need for new treatment options. The aim of the present study was to investigate the effects of vacuum-assisted closure (VAC) therapy on the difficult recovery process following the operation. Methods: The study was conducted on 23 patients diagnosed with Fournier gangrene who applied to our clinic between July 2010 and October 2014. All parameters in the clinical study were evaluated retrospectively. Fournier gangrene diagnosis was based on the criteria defined by Fisher et al. in 1979. On postoperative day 1, all patients were re-debrided, and the wounds were dressed with silver nitrate VAC. Patients included in the study were evaluated based on age, comorbidities, duration of the surgical procedure, number of debridement procedures, duration of hospitalization, duration of VAC use, mortality, blood transfusion, and need for enterostomy. Results: The mean age of the patients was 61.5 +/- 7.6 (48-77) years. The total operation time was 52 (30-98) min. The average number of debridement procedures was 1.6 (1-3) Clinical examination and laboratory tests of 23 patients in our clinic showed that 17 patients met the sepsis criteria. Of the 17 patients, nine had kidney failure, five had respiratory organ failure, and three had adequate organ failure. The wound of 11 out of 21 patients was closed primarily. The remaining 10 patients were closed with plastic surgery. The mean duration of VAC was 12.8 +/- 3.7 (3-21), and the mean duration of hospitalization was 13.8 +/- 3.7 (4-22). Conclusion: Owing to high rates of mortality, there is still a search for new treatment options for Fournier gangrene. VAC treatment is indicated to decrease the duration of hospitalization and number of debridement procedures. The decrease in the duration of hospitalization also decreases the number of work days lost.