EVALUATION OF THE EFFECT OF VACUUM ASSISTED CLOSURE IN THE SURGICAL MANAGEMENT OF FOURNIER'S GANGRENE: A SINGLE CENTER EXPERIENCE

Yıl 2022, Cilt: 39 Sayı: 3, 838 - 841, 30.08.2022

Mikail Uyan , Türker Acehan

Öz

Fournier's gangrene is a surgical emergency that arises in the perineum and genital area and is characterized as necrotizing fasciitis of the perineum and genital area. It quickly spreads between the fascial planes and causes soft tissue necrosis. Diabetes mellitus is the most prevalent predisposing factor. Early diagnosis and management are critical in the progression of the disease. Surgical debridement and wide-spectrum antibiotic therapy are the first steps in treatment. Despite advancements in diagnosis and treatment procedures, as well as changes in critical care techniques, the disease has a death rate of 16-40%. The research involves comparisons of patients who were operated on for Fournier's gangrene between January 2016 and January 2022, including those who were treated with vacuum assisted closure tecnique vs those who were not. Data on the patients' demographic and clinical features was acquired and analyzed from hospital records. The study involved the involvement of 16 patients. 6 patients (38%) were in Group 1 and 10 patients (62%) were in Group 2. There were 11 men (68 %) and 5 women (32%). Swelling in the wound region was the most prevalent complaint. The most common site of gangrene was the perianal region, and diabetes was the most common predisposing condition. Group 2 had a significantly shorter hospital stay (p=0.02). Between groups, there was no statistically significant difference in mortality or other parameters. The main advantages of VAC therapy are that it requires fewer dressings, causes less pain, and reduces the risk of contamination. The advantages of the traditional wet dressing include its ease of use and low cost, as well as the fact that VAC therapy promotes faster wound healing and shorter hospital stays.

Anahtar Kelimeler

Fournier, vacuum assisted closure, surgical treatment

Kaynakça

• 1. Norton KS, Johnson LW, Perry T, Perry KH, Sehon JK, Zibari GB. Management of Fournier’s gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment. Am Surg. 2002;68: 709-713.
• 2. Atakan IH, Kaplan M, Kaya E, Aktoz T, Inci O. A life-threatening infection: Fournier’s gangrene. Int Urol Nephrol. 2002;34: 387-392.
• 3. Geraci G, Pisello F, Lupo F, Cajozzo M, Sciume C, Modica G. Fournier’s gangrene: case report and review of recent literature. Ann Ital Chir. 2004;75: 97-106.
• 4. Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, et al. Fournier’s 336 gangrene and its emergency management, Postgrad Med J 2006; 82(970):516-9.
• 5. Meleney F: Hemolytic Streptococcus gangrene, Arch Surg.1924;9:317-64.
• 6. Unal B, Kocer B, Ozel E, Bozkurt B, Yildirim O, Altun B, et al. Fournier gangrene. Approaches to diagnosis and treatment. Saudi Med J 2006; 27: 1038-1043.
• 7. Hejase MJ, Simonin JE, Bihrle R, Coogan CL. Genital Fournier's gangrene: experience with 38 patients. Urology.1996;47(5):734- 39.
• 8. Benizri E, Fabiani P, Migliori G, Chevallier D, Peyrottes A, Raucoules M, et al. Gangrene of the perineum. Urology. 1996;47(6):935-39.
• 9. Oguz A, Gümüş M, Turkoglu A, Bozdag Z, Ülger BV, Agaçayak E. Fournier's Gangrene: A Summary of 10 Years of Clinical Experience. International surgery. 2015;100(5):934-41.
• 10. Jeong HJ, Park SC, Seo IY, Rim JS. Prognostic factors in Fournier gangrene. International journal of urology : official journal of the Japanese Urological Association. 2005;12(12):1041-44.
• 11. Morpurgo E, Galandiuk S. Fournier's gangrene. The Surgical clinics of North America. 2002;82(6):1213-24.
• 12. Pour SM. Use of negative pressure wound therapy with silver base dressing for necrotizing fasciitis. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society. 2011;38(4):449- 52.
• 13. Canbaz H, Çağlıkülekçi M, Altun U, Dirlik M, Türkmenoğlu Ö, Taşdelen B, et al. Fournier’s gangrene: analysis of risk factors affecting the prognosis and cost of therapy in 18 cases. Turkish Journal of Trauma & Emergency Surgery. 2010; 16(1): 71-76.
• 14. Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. The American surgeon. 1998;64(5):397-400.
• 15. Sockkalingam VS, Subburayan E, Velu E, Rajashekar ST, Swamy AM. Fournier's gangrene: prospective study of 34 patients in South Indian population and treatment strategies. Pan African medical journal. 2018;12(31):110.
• 16. Sorensen MD, Krieger JN, Rivara FP, Klein MB, Wessells H. Fournier's gangrene: management and mortality predictors in a population based study. The Journal of urology. 2009;182(6):2742-47.
• 17. Yeniyol CO, Suelozgen T, Arslan M, Ayder AR. Fournier's gangrene: experience with 25 patients and use of Fournier's gangrene severity index score. Urology. 2004;64(2):218-22.
• 18. Smith GL, Bunker CB, Dinneen MD. Fournier's gangrene. British journal of urology. 1998;81(3):347-55.
• 19. Consten EC, Slors JFM, Danner SA, Sars PR, Obertop H, Lanschot JJV. Severe complications of perianal sepsis in patients with human immunodeficiency virus. Br J Surg.1996;83(6):778-80.
• 20. Fajdic J, Gotovac N, Hrgovic Z. Fournier gangrene: our approach and patients. Urol Int. 2011;87(2):186-91.
• 21. Korkut M, Icöz G, Dayangaç M, Akgün E, Yeniay L, Erdoğan O, et al. Outcome analysis in patients with Fournier’s gangrene: report of 45 cases. Dis Colon Rectum.2003;46(5):649- 52.
• 22. Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg.2000;87(6):718-28.
• 23. Villanueva-Sáenz E, Hernández-Magro PM, Ovalle MV, Vega JM, Alvarez-Tostado JF. Experience in management of Fournier's gangrene. Techniques in coloproctology.2002;6(1):5- 10.
• 24. Ozkan OF, Koksal N, Altinli E, Celik A, Uzun MA, Cıkman O, et al. Fournier's gangrene current approaches. International wound journal. 2016;13(5):713-16.
• 25. Ozturk E, Ozguc H, Yilmazlar T. The use of vacuum assisted closure therapy in the management of Fournier's Gangrene. American journal of surgery. 2009;197(5):660-65.
• 26. Arslan E, Ozturk OG, Aksoy A, Polat G. Vacuum-assisted closure therapy leads to an increase in plasma fibronectin level. International wound journal. 2011;8(3):224- 28.
• 27. Assenza M, Cozza V, Sacco E, Clementi I, Tarantino B, Passafiume F, et al. VAC (Vacuum Assisted Closure) treatment in Fournier’s gangrene: personal experience and literature review. Clin Ter.2011; 162: 1-5.
• 28. Insua-Pereira I, Ferreira PC, Teixeira S, Barreiro D, Silva A. Fournier's gangrene: a review of reconstructive options. Central European journal of urology. 2020;73(1):74-79.
• 29. Taviloglu K, Cabioglu N, Cagatay A, Yanar H, Ertekin C, Baspinar I, et al. Idiopathic necrotizing fasciitis: risk factors and strategies for management. Am Surg.2005; 71: 315-320.
• 30. Pawłowski W, Wronski M, Krasnodebski IW. Fournier’s gangrene. Pol Merkur Lekarski.2004; 17: 85-87.