Use of NPTWi in Fournier's gangrene

Abstract

Aim: Fournier's gangrene (FG) is defined as a fulminant form of infective necrotizing fascitis of the perineal, genital or perianal regions. Even with appropriate treatment approaches, mortality is high as 4 to 67%. There have been many advances in management of Fournier gangrene including use of vacuum assisted closure and hyperbaric oxygen therapy. Methods: a 72 y.o. male with swelling, redness, pain on palpating and necrosis of the penis, scrotum and perineal area including the perianal area, with diabetes mellitus type II, previous non Hodgkin lymphoma recent surgery for perianal fistula, was admitted in our clinic. Because of the extensive involvement of the anus and its sphincter was necessary, as the first surgical time, the packaging of a terminal colostomy on sigma. After that, he underwent radical surgical debridement with excision of all necrotic material (fig1). Have been made abundant washing with hydrogen peroxide and betadine. Was used negative pressure wound therapy with controlled instillation of fluids (NPTWi)(fig2). The treatment was then completed with hyperbaric oxygen therapy. This treatment was performed for 40 days until discharge. Results: the surgical treatment associated with NPTWi and hyperbaric oxygen therapy have allowed the resolution of the septic and an almost complete wound healing (fig3). Conclusions: Early recognition and aggressive surgical excision are mandatory for success in patients with Fournier's gangrene. The use of NPTWi in the treatment of Fournier's gangrene improves clinical outcomes and reduces hospital stay.