Login to Access Video or Poster Abstract: MP79-05
Sources of Funding: None

Introduction

Fournier's gangrene (FG) has been a dreadful entity since first described in the late 19th century. Initial management includes hemodynamic stabilization, broad-spectrum antibiotics, and aggressive surgical debridement. Moreover, posterior wound management and closure, which requires multiple surgical procedures and prolonged hospitalizations, has always been a multidisciplinary challenge. We want to report our experience, involving a single-stage delayed primary closure (DPC) of FG, using mattress sutures and a non-slip knot technique, which aims to reduce patient's admission time and necessity for multiple operations.

Methods

Retrospective analysis of 27 patients who underwent surgical management over the last three years due to FG. All patients underwent wide local debridement and DPC, using the same technique, involving the placement of interrupted Prolene mattresses along the wound edges and sequential wound re-approximation. Patients were analyzed in respect to age, comorbidities, total area and volume of resection, hospitalization time, and WBC at the time of admission.

Results

Mean patient age was 57.7 years (range 45-82 years). Most prevalent comorbidities were diabetes mellitus and hypertension (55% of cohort). Other comorbidities included alcohol dependence, obesity, and peripheral vascular disease. The average resected area was 89 cm2 (12-225 cm2), with resection volume of 224 cm3 (18-700 cm3). Average hospitalization was 8.2 days (2-19 days). Mean WBC count at the time of admission was 16.7 thousand cells/mcL (6.6-33). Four patients required a secondary procedure, three for revision due to persistent soft tissue defects, and other for a general surgery procedure. Only three patients received supplementary hyperbaric therapy during the delayed closure time. After discharge, all patients were followed at least once, within 2 weeks after discharge, and none required further surgical management or re-hospitalization. When compared to a matched cohort of patients with similar characteristics, the admission time and the need for secondary procedures was diminished, and results were statistically significant.

Conclusions

Our data show that patients with FG can be safely managed with delayed primary wound closure. Also, the necessity for expensive supportive therapies and reoperation is decreased. This may translate into improved wound healing, cosmesis, and shorter hospitalization time. Moreover, this method may become an option for well-selected patients with defects not requiring tissue grafting.

Funding

None