353 Improving Outcomes in Fournier’s Gangrene Using Skin and Soft Tissue Sparing Flap Preservation Surgery: An Alternative Approach to Wide Radical Debridement

Abstract

Fournier’s Gangrene remains a formidable disease that initially requires a high degree of suspicion followed by early diagnosis, prompt surgical intervention and targeted antibiotic therapy. Surgical management is wide radical excision which often includes an “everything including the kitchen sink” philosophy as a means of sepsis damage control. This in turn often leaves survivors with large morbid wounds requiring complex soft tissue coverage and prolonged hospitalizations. We report a nine-year retrospective case series review of Fournier’s Gangrene (FG) treated in our burn and wound center in which large skin and soft tissue sparing flap preservation was achieved. This series illustrates an approach to skin and soft tissue sparing surgery in 15 consecutive cases of FG since 2008. All patients underwent simultaneous serial debridement, partial complex wound closure and negative pressure wound therapy (NPWT) of spared skin and soft tissue flaps. The mean number of surgeries was 5.53. The average number of days from initial consult to wound closure was 25.4 days. Ninety-three percent required no surgical fecal diversion. Delayed primary closure (DPC) was achieved in 100% of the patients using this reproducible technique. Less than 1.5 percent (1.3%) required split thickness skin grafting as part of wound closure. There were no mortalities in this group of patients. Our average ICU and hospital length of stay (LOS) was 2.67 and 18.40 days respectively. Greater than fifty percent (53.3%) were partially managed as an outpatient during wound closure. Their mean number of outpatient management days was 9.47 during DPC. We report a series of 15 consecutive patients with Fournier’s in whom large skin and soft flap preservation was safely achieved. Thinking outside the box all patients underwent a specific alternative technique of concurrent debridement, DPC and NPWT; ultimately achieving faster times to closure, decreased total number of operations, decreased ICU LOS, decreased hospital LOS and better cosmetic and functional outcomes without compromising safe NSTI surgical management. Presents an alternative approach to skin and soft tissue management of necrotizing soft tissue infections during a time where there is pressure to get safe, effective and efficient outcomes in a timely manner.