Treatment of Fournier's Gangrene with Combination of Vacuum-Assisted Closure Therapy, Hyperbaric Oxygen Therapy, and Protective Colostomy

Giovanni Zagli,Lorenzo Bonetti,Adriano Peris,Sara Degl'Innocenti,Giovanni Cianchi,Paolo Prosperi,Jessyca Parodo

doi:10.1155/2011/430983

Giovanni Zagli, Lorenzo Bonetti + Show 5 more

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https://doi.org/10.1155/2011/430983

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Abstract

Fournier's gangrene is a rare process which affects soft tissue in the genital and perirectal area. It can also progress to all different stages of sepsis, and abdominal compartment syndrome can be one of its complications. Two patients in septic shock due to Fournier gangrene were admitted to the Intensive Care Unit of Emergency Department. In both cases, infection started from the scrotum and the necrosis quickly involved genitals, perineal, and inguinal regions. Patients were treated with surgical debridement, protective colostomy, hyperbaric oxygen therapy, and broad-spectrum antibacterial chemotherapy. Vacuum-assisted closure (VAC) therapy was applied to the wound with the aim to clean, decontaminate, and avoid abdominal compartmental syndrome development. Both patients survived and were discharged from Intensive Care Unit after hyperbaric oxygen therapy cycles and abdominal closure.

Highlights

Fournier’s gangrene is a rare necrotizing fasciitis of the perineal, genital, or perianal regions [1]
The patient underwent 22 days of Vacuum-assisted closure (VAC) therapy and 14 hyperbaric oxygen therapy sessions. 24 days after Intensive Care Unit (ICU) admission, the patient was discharged to a high-dependency unit
VAC therapy was applied on the wound at the end of the surgical procedure, and hyperbaric oxygen therapy was started the day

Summary

Introduction

Fournier’s gangrene is a rare necrotizing fasciitis of the perineal, genital, or perianal regions [1]. It is characterized by obliterative endarteritis and thrombosis of the subcutaneous arteries resulting in gangrene of the subcutaneous tissue and overlying skin. Fournier’s gangrene usually starts with perianal or perineal pain, which is often disproportionate to the physical finding such as swelling or pruritus in the affected area. Fournier’s gangrene is a polymicrobial, synergistic, and necrotizing infection of the perineal subcutaneous fascia and male genitalia that originates from the skin, urethra, or rectum. We report two cases of septic shock due to Fournier’s gangrene which recovered well, treated with surgical debridement, hyperbaric oxygen therapy, and vacuum-assisted closure (VAC) therapy

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