Comparison of Conventional Wet Dressing and Vacuum Assisted Closure with Hypochlorous Acid Application in Fournier Gangrene Treatment

Abstract

Background: Bacterial toxins cause local tissue damage and necrosis. This can continue until a significant amount of tissue becomes necrotic. Neutralization of bacterial toxins improves results. Low concentrations of Hypochlorous Acid can be antimicrobial without causing cytotoxicity in normal cells in the wound and surrounding tissues. In this study, we aimed to compare the results of patients treated with hypochlorous acid (0.01% w/v) through Vacuum Assisted Closure and with traditional wet dressing after surgical debridement due to Fournier Gangrene in our clinic. Materials and Methods: 73 patients treated for Fournier Gangrene between 2009-2019 in our clinic were evaluated retrospectively. The patients were divided into two groups: those who received Hypochlorous Acid with Vacuum Assisted Closure (Group A, n = 30) and those who received traditional wet dressing (Group B, n = 42) after the first debridement. Hypochlorous Acid (0.01% w/v), known to destroy bacteria and bacterial toxins, was administered to 30 patients with Fournier Gangrene in saline with a pH of 4-5, 5-6 times a day. Using Vacuum Assisted Closure, 5-10 ml of 0.01% Hypochlorous Acid was applied to the wound and aspirated. For wet dressing application, the wound was closed by applying mupirocin calcium and rifamycin to an appropriate number of wet sponges suitable for the wound surface and depth after cleansing the wound with sponges moistened with isotonic 3 times a day. The collected data were compared. P values smaller than 0.05 were considered significant. Results: The hospitalization time and wound healing time of 30 patients who received Hypochlorous Acid with Vacuum Assisted Closure were shorter (p <0.05), and the number of patients requiring secondary debridement was also lower (p <0.05). Conclusion: Hypochlorous Acid application with Vacuum Assisted Closure is an effective, successful and important postoperative treatment and wound care method that provides shorter hospital stay and faster recovery time. Toxicity and immune dysfunction due to bacterial toxins and toxins released from damaged cells can be alleviated with 0.01 Hypochlorous Acid application via Vacuum Assisted Closure. We recommend this method, which is easy to apply and inexpensive in certain Fournier Gangrene cases.