Yuan Tian, Ting Liu and Chuan-qi Zhao contributed equally to this work.
Perineum necrotizing fasciitis, also known as Fournier gangrene (FG), is a rare but highly mortal infectious necrotizing fasciitis with or without involvement of the underlying muscle. Evidence exists that negative pressure wound therapy (NPWT) combined with a split thickness skin graft (STSG) can help to heal wounds with FG. However, when the wound spreads to the anal area, it can easily be contaminated by faeces, causing a more extensive wounds; thus, faecal diversion is considered. Here, we report a case of extensive perineum necrotizing fasciitis that spread to near the anus; NPWT combined with STSGs was used to help heal the wound without faecal diversion.
A 47-year-old male patient was admitted with extensive perineum fascia necrosis caused by Pseudomonas aeruginosa that rapidly spread to near the anus. After comprehensive therapy completed wound bed preparation, STSGs from the scalp were grafted to the wound, and NPWT was applied to improve STSGs survival and seal the anus without faecal diversion.
After treatment, graft take was 95%, and the exposed testicular and residual wounds were repaired with a local skin flap. At discharge, the wound had decreased to two pea-sized areas. The patient received conventional moist gauze therapy to close the residual wound at the local hospital. A follow-up by telephone 1 month later showed that both wounds had healed and that the patient was satisfied with the outcome.
NPWT use combined with STSGs to cover the whole wound and the anus without faecal diversion is a safe and effective method to help with wound healing and avoid contamination with excrement.
Ozkan OF, et al. Fournier's gangrene current approaches. Int Wound J. 2016;13(5):713–6. CrossRef
Ferreira MC, et al. Complex wounds Clinics (Sao Paulo). 2006;61(6):571–8. CrossRef
Morpurgo E, Galandiuk S. Fournier's gangrene. Surg Clin North Am. 2002;82(6):1213–24. CrossRef
Hong KS, et al. Prognostic factors and treatment outcomes for patients with Fournier's gangrene: a retrospective study. Int Wound J. 2017;14(6):1352–8. CrossRef
Ye J, et al. Negative pressure wound therapy applied before and after Split-thickness skin graft helps healing of Fournier gangrene. Medicine. 2015;94(5):e426. CrossRef
Ozkan OF, et al. Combining flexi-seal and negative pressure wound therapy for wound management in Fournier's gangrene. Int Wound J. 2015;12(3):364–5. CrossRef
Yanar H, et al. Fournier's gangrene: risk factors and strategies for management. World J Surg. 2006;30(9):1750–4. CrossRef
Altarac S, et al. Fournier's gangrene: etiology and outcome analysis of 41 patients. Urol Int. 2012;88(3):289–93. CrossRef
Top, H., et al., Distally based sural flap in treatment of chronic venous ulcers. Ann Plast Surg, 2005. 55(2): p. 160–5; discussion 166–8. CrossRef
Medina. P.J., et al., [Fournier gangrene: evaluation of prognostic factors in 90 patients]. Actas Urol Esp. 2008;32(10):1024–30. CrossRef
Lee KT, et al. Negative-pressure wound dressings to secure split-thickness skin grafts in the perineum. Int Wound J. 2014;11(2):223–7. CrossRef
Yaghan RJ, Al-Jaberi TM, Bani-Hani I. Fournier's gangrene: changing face of the disease. Dis Colon Rectum. 2000;43(9):1300–8. CrossRef
Ludolph I, et al. Penile reconstruction with dermal template and vacuum therapy in severe skin and soft tissue defects caused by Fournier's gangrene and hidradenitis suppurativa. Int Wound J. 2016;13(1):77–81. CrossRef
Vuerstaek, J.D., et al., State-of-the-art treatment of chronic leg ulcers: a randomized controlled trial comparing vacuum-assisted closure (V.a.C.) with modern wound dressings. J Vasc Surg, 2006. 44(5): p. 1029–37; discussion 1038. CrossRef
- Negative pressure wound therapy and split thickness skin graft aided in the healing of extensive perineum necrotizing fasciitis without faecal diversion: a case report
- BioMed Central
Neu im Fachgebiet Chirurgie
Mail Icon II