MP35-07 COMPONENT SEPARATION CLOSURE OF FOURNIER'S GANGRENE DEFECTS DECREASES THE NEED FOR SPLIT THICKNESS SKIN GRAFTING

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP35)1 Sep 2021MP35-07 COMPONENT SEPARATION CLOSURE OF FOURNIER'S GANGRENE DEFECTS DECREASES THE NEED FOR SPLIT THICKNESS SKIN GRAFTING Hayden Warner, Blaize Kandler, Shawn Sexton, Jason Sandberg, Jacob Oleson, and Bradley Erickson Hayden WarnerHayden Warner More articles by this author , Blaize KandlerBlaize Kandler More articles by this author , Shawn SextonShawn Sexton More articles by this author , Jason SandbergJason Sandberg More articles by this author , Jacob OlesonJacob Oleson More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002044.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: FG management is performed by either reconstructive urology (RU) or surgery/burn (SB) at our institution. Component separation closure (CSC) has become method by the RUs over split-thickness skin grafting (STSG), which is still favored by SB. The purpose of this study was to compare surgical management and outcomes between these cohorts and to determine patient and wound predictors for the need for split thickness skin grafting and post-operative wound morbidity. METHODS: Between 2009-19, 138 men underwent debridement for FG; 82 (59%) were managed with debridement alone (+/- wound vac (WV)), and 8 (6%) died w/in 72 hours, leaving 48 that underwent surgical reconstruction. Reconstruction was performed by RU (n=29) and BP (n=19). FG anatomical extent (AE) was categorized as none (0), <50% (1) and >50% (2) for the penis, scrotum, perineum and suprapubic region, with a total AE score that ranged from 1 (min) to 8 (max). CSC involves debridement of granulation tissue with a VERSAJET, aggressive mobilization of skin flaps and involved spermatic cords+/-hydrocelectomy, with the goal of primary closure of all defects when a tension free anastomosis can be obtained and sexual/urinary compromise is not predicted. Closure over a drain is performed with 2-0 polygactin (deep) and 3-0 nylon interrupted for skin. Unclosed areas after CSC are treated with either STSG or secondary intention+/-WV (Figure 1). RESULTS: Cohort FG AE is depicted in Figure 2, with scrotum (n=44, 92%) and perineum (n=29, 60%) being most affected. STSG was utilized in 100% of cases closed by SB and 31% (9/29) closed by RU, though mean AE was higher in SB managed wounds versus RU (4.5 v 2.7, p=0.001). STSG use by RUs was predicted by site number with >50% loss (each site OR 4.1,p=0.0017) and total AE (each point OR 3.2,p=0.0156) controlling for age, BMI and days to closure. Minor and major (requiring intervention) wound morbidity was noted in 13 (27%) and 3 (6%), not predicted by RU/SB, AE or STSG use. CONCLUSIONS: CSC of FG wounds significantly decreases the need for STSG without increasing wound morbidity. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e629-e629 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hayden Warner More articles by this author Blaize Kandler More articles by this author Shawn Sexton More articles by this author Jason Sandberg More articles by this author Jacob Oleson More articles by this author Bradley Erickson More articles by this author Expand All Advertisement Loading ...