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The Effect of Vacuum-Assited Closure (VAC) on Wound and Graft Healing in Fournier’s Gangrene

Yıl 2023, Cilt: 45 Sayı: 6, 923 - 927, 24.10.2023
https://doi.org/10.20515/otd.1350645

Öz

Fournier's Gangrene (FG) has been described as an aggressive necrotizing fasciitis that affects the perineal, perianal, or genital areas. Aggressive and complete surgical debridement of necrotic tissues should be performed in the early period in FG. We aimed to compare VAC and conventional dressing in the treatment of FG in terms of the time elapsed between initial surgery and grafting and the need for secondary debridement after grafting. The data of 48 patients who were diagnosed with FG by our Urology Clinic between 2015 and 2023, underwent surgical treatment and graft tissue closure were retrospectively analyzed. Clinical, pathophysiological features, predisposing factors, use of VAC or conventional dressings, number of graft losses, length of hospital stay were recorded. VAC and conventional groups were evaluated comparatively Of the total 48 patients who were followed up and treated with Fournier's Gangrene, 25 (52%) used VAK dressing in the postoperative period, while conventional dressing was used in 23 (48%). The mean length of hospital stay was 28 days in the VAC group, 48 days in the conventional group and significantly shorter in the VAC group. (p = 0.017). It was determined that secondary debridement was required after graft closure in 2 patients in the VAK group and in 6 patients in the conventional dressing group. Graft loss rates were statistically significantly less in the VAC dressing group than in the conventional dressing group. VAC treatment in FG accelerates wound healing, shortens hospital stay, and reduces secondary surgical intervention rates after tissue closure with grafting.

Kaynakça

  • 1. Fournier JA (1883) Gangrene foudroyante de la verge. Med Pract 4:589–597
  • 2. Mallikarjuna MN, Vijayakumar A, Patil VS, Shivswamy BS. Fournier's Gangrene: Current Practices. ISRN Surg. 2012;2012:942437. doi: 10.5402/2012/942437. Epub 2012 Dec 3.
  • 3. Smith GL, Bunker CB, Dinneen MD. Fournier's gangrene. Br J Urol. 1998 Mar;81(3):347-55.
  • 4. Sorensen MD, Krieger JN. Fournier's Gangrene: Epidemiology and Outcomes in the General US Population. Urol Int. 2016;97(3):249-259..
  • 5. Stone HH, Martin JD Jr. Synergistic necrotizing cellulitis. Ann Surg. 1972 May;175(5):702-11.
  • 6. Rodríguez Alonso A, Pérez García MD, Núñez López A, Ojea Calvo A, Alonso Rodrigo A, Rodríguez Iglesias B, Barros Rodríguez JM, Benavente Delgado J, Nogueira March JL. Gangrena de Fournier: aspectos anátomo-clínicos en el adulto y en el niño. Actualización terapéutica [Fournier's gangrene: anatomo-clinical features in adults and children. Therapy update]. Actas Urol Esp. 2000 Apr;24(4):294-306. Spanish.
  • 7. Eke N. Fournier's gangrene: a review of 1726 cases. Br J Surg. 2000 Jun;87(6):718-28.
  • 8. Chennamsetty A, Khourdaji I, Burks F, Killinger KA. Contemporary diagnosis and management of Fournier's gangrene. Ther Adv Urol. 2015 Aug;7(4):203-15.
  • 9. Pastore AL, Palleschi G, Ripoli A, Silvestri L, Leto A, Autieri D, Maggioni C, Moschese D, Petrozza V, Carbone A. A multistep approach to manage Fournier's gangrene in a patient with unknown type II diabetes: surgery, hyperbaric oxygen, and vacuum-assisted closure therapy: a case report. J Med Case Rep. 2013 Jan 3;7:1
  • 10. Bonkat G, Bartoletti RR, Bruyère F et al (2019) European Association of Urology - Infections in Urology Guidelines Panel, Copenhagen, EAU Guidelines Office, Arnhem. ISBN 978-94-92671-02-8
  • 11. Snyder N 4th, Gould LJ. Scrotal and penile reconstruction using the vacuum-assisted closure device. Can J Plast Surg. 2005 Winter;13(4):205-6.
  • 12. Ozturk E, Ozguc H, Yilmazlar T. The use of vacuum assisted closure therapy in the management of Fournier's gangrene. Am J Surg. 2009 May;197(5):660-5; discussion 665.
  • 13. Hagedorn JC, Wessells H. A contemporary update on Fournier's gangrene. Nat Rev Urol. 2017 Apr;14(4):205-214.
  • 14. Yanaral F, Balci C, Ozgor F, Simsek A, Onuk O, Aydin M, Nuhoglu B. Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier's gangrene. Arch Ital Urol Androl. 2017 Oct 3;89(3):208-211.
  • 15. Yücel M, Özpek A, Başak F, Kılıç A, Ünal E, Yüksekdağ S, Acar A, Baş G. Fournier's gangrene: A retrospective analysis of 25 patients. Ulus Travma Acil Cerrahi Derg. 2017 Sep;23(5):400-404.
  • 16. Czymek R, Schmidt A, Eckmann C, Bouchard R, Wulff B, Laubert T, Limmer S, Bruch HP, Kujath P. Fournier's gangrene: vacuum-assisted closure versus conventional dressings. Am J Surg. 2009 Feb;197(2):168-76.
  • 17. Korkut M, Içöz G, Dayangaç M, Akgün E, Yeniay L, Erdoğan O, Cal C. Outcome analysis in patients with Fournier's gangrene: report of 45 cases. Dis Colon Rectum. 2003 May;46(5):649-52
  • 18. Assenza M, Cozza V, Sacco E, Clementi I, Tarantino B, Passafiume F, Valesini L, Bartolucci P, Modini C. VAC (Vacuum Assisted Closure) treatment in Fournier's gangrene: personal experience and literature review. Clin Ter. 2011;162(1):e1-5.
  • 19. Cuccia G, Mucciardi G, Morgia G, Stagno d'Alcontres F, Galì A, Cotrufo S, Romeo M, Magno C. Vacuum-assisted closure for the treatment of Fournier's gangrene. Urol Int. 2009;82(4):426-31.
  • 20. Iacovelli V, Cipriani C, Sandri M, Filippone R, Ferracci A, Micali S, Rocco B, Puliatti S, Ferrarese P, Benedetto G, Minervini A, Cocci A, Pastore AL, Al Salhi Y, Antonelli A, Morena T, Volpe A, Poletti F, Celia A, Zeccolini G, Leonardo C, Proietti F, Finazzi Agrò E, Bove P. The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER'S gangrene: a retrospective multi-institutional cohort study. World J Urol. 2021 Jan;39(1):121-128

Fournier Gangreni’nde Vakum Yardımlı Kapama (Vak)’nın Yara İyileşmesi ve Greft Uyumu Üzerine Etkisi

Yıl 2023, Cilt: 45 Sayı: 6, 923 - 927, 24.10.2023
https://doi.org/10.20515/otd.1350645

Öz

Giriş:
Fournier Gangreni (FG), perineal, perianal veya genital bölgeleri etkileyen agresif bir nekrotizan fasiit olarak tanımlanmıştır. FG’de nekrotik dokuların erken dönemde agresif ve tam cerrahi debridmanı yapılmalıdır. FG'nin tedavisinde VAK ve konvansiyonel pansumanu karşılaştırarak, başlangıç cerrahisi ile greftleme arasında geçen süre ve greftleme sonrası sekonder debritman gereksinimi açısından incelemeyi amaçladık.
Materyal-Metod:
2015- 2023 yılları arasında Üroloji Kliniği’mizce FG tanısı konularak cerrahi tedavi uygulanan ve greft ile doku kapama yapılmış 48 hastanın verileri retrospektif incelendi. Hastaların klinik, patofizyolojik özellikleri, predispozan faktörler, VAK veya konvansiyonel pansuman kullanımı, greft kaybı sayıları, hastanede kalış süreleri kaydedildi. VAK ve konvansiyel pansuman yapılan gruplar karşılaştırılmalı değerlendirildi.
Bulgular:
Fournier Gangreni tanısı ile takip ve tedavi edilen toplam 48 hastanın 25’inde (%52) postoperatif dönemde VAK pansuman kullanılırken, 23’ünde (%48) konvansiyonel pansuman kullanılmıştı. Ortalama hastanede yatış süreleri, VAK grubunda 28 gün , konvansiyonel grupta 48 gün olarak tespit edilmiş ve VAK grubunda anlamlı olarak daha kısa saptandı. (p = 0.008). VAK grubunda 2 hastada , konvansiyonel pansuman yapılan hasta grubunda 6 hastada greft ile kapama sonrası sekonder debritman gerekli olduğu tespit edildi.Greft kaybı oranları VAK pansuman yapılan grupta, konvansiyonel pansuman yapılan gruba göre istatistiksel anlamlı daha azdı.

Sonuç:
FG ‘de VAK tedavisi yara iyileştirmesini hızlandırmakta, hastanede kalış süresini kısaltmakta ve greft ile doku kapama sonrası ikincil cerrahi girişim oranlarını azaltmaktadır

Kaynakça

  • 1. Fournier JA (1883) Gangrene foudroyante de la verge. Med Pract 4:589–597
  • 2. Mallikarjuna MN, Vijayakumar A, Patil VS, Shivswamy BS. Fournier's Gangrene: Current Practices. ISRN Surg. 2012;2012:942437. doi: 10.5402/2012/942437. Epub 2012 Dec 3.
  • 3. Smith GL, Bunker CB, Dinneen MD. Fournier's gangrene. Br J Urol. 1998 Mar;81(3):347-55.
  • 4. Sorensen MD, Krieger JN. Fournier's Gangrene: Epidemiology and Outcomes in the General US Population. Urol Int. 2016;97(3):249-259..
  • 5. Stone HH, Martin JD Jr. Synergistic necrotizing cellulitis. Ann Surg. 1972 May;175(5):702-11.
  • 6. Rodríguez Alonso A, Pérez García MD, Núñez López A, Ojea Calvo A, Alonso Rodrigo A, Rodríguez Iglesias B, Barros Rodríguez JM, Benavente Delgado J, Nogueira March JL. Gangrena de Fournier: aspectos anátomo-clínicos en el adulto y en el niño. Actualización terapéutica [Fournier's gangrene: anatomo-clinical features in adults and children. Therapy update]. Actas Urol Esp. 2000 Apr;24(4):294-306. Spanish.
  • 7. Eke N. Fournier's gangrene: a review of 1726 cases. Br J Surg. 2000 Jun;87(6):718-28.
  • 8. Chennamsetty A, Khourdaji I, Burks F, Killinger KA. Contemporary diagnosis and management of Fournier's gangrene. Ther Adv Urol. 2015 Aug;7(4):203-15.
  • 9. Pastore AL, Palleschi G, Ripoli A, Silvestri L, Leto A, Autieri D, Maggioni C, Moschese D, Petrozza V, Carbone A. A multistep approach to manage Fournier's gangrene in a patient with unknown type II diabetes: surgery, hyperbaric oxygen, and vacuum-assisted closure therapy: a case report. J Med Case Rep. 2013 Jan 3;7:1
  • 10. Bonkat G, Bartoletti RR, Bruyère F et al (2019) European Association of Urology - Infections in Urology Guidelines Panel, Copenhagen, EAU Guidelines Office, Arnhem. ISBN 978-94-92671-02-8
  • 11. Snyder N 4th, Gould LJ. Scrotal and penile reconstruction using the vacuum-assisted closure device. Can J Plast Surg. 2005 Winter;13(4):205-6.
  • 12. Ozturk E, Ozguc H, Yilmazlar T. The use of vacuum assisted closure therapy in the management of Fournier's gangrene. Am J Surg. 2009 May;197(5):660-5; discussion 665.
  • 13. Hagedorn JC, Wessells H. A contemporary update on Fournier's gangrene. Nat Rev Urol. 2017 Apr;14(4):205-214.
  • 14. Yanaral F, Balci C, Ozgor F, Simsek A, Onuk O, Aydin M, Nuhoglu B. Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier's gangrene. Arch Ital Urol Androl. 2017 Oct 3;89(3):208-211.
  • 15. Yücel M, Özpek A, Başak F, Kılıç A, Ünal E, Yüksekdağ S, Acar A, Baş G. Fournier's gangrene: A retrospective analysis of 25 patients. Ulus Travma Acil Cerrahi Derg. 2017 Sep;23(5):400-404.
  • 16. Czymek R, Schmidt A, Eckmann C, Bouchard R, Wulff B, Laubert T, Limmer S, Bruch HP, Kujath P. Fournier's gangrene: vacuum-assisted closure versus conventional dressings. Am J Surg. 2009 Feb;197(2):168-76.
  • 17. Korkut M, Içöz G, Dayangaç M, Akgün E, Yeniay L, Erdoğan O, Cal C. Outcome analysis in patients with Fournier's gangrene: report of 45 cases. Dis Colon Rectum. 2003 May;46(5):649-52
  • 18. Assenza M, Cozza V, Sacco E, Clementi I, Tarantino B, Passafiume F, Valesini L, Bartolucci P, Modini C. VAC (Vacuum Assisted Closure) treatment in Fournier's gangrene: personal experience and literature review. Clin Ter. 2011;162(1):e1-5.
  • 19. Cuccia G, Mucciardi G, Morgia G, Stagno d'Alcontres F, Galì A, Cotrufo S, Romeo M, Magno C. Vacuum-assisted closure for the treatment of Fournier's gangrene. Urol Int. 2009;82(4):426-31.
  • 20. Iacovelli V, Cipriani C, Sandri M, Filippone R, Ferracci A, Micali S, Rocco B, Puliatti S, Ferrarese P, Benedetto G, Minervini A, Cocci A, Pastore AL, Al Salhi Y, Antonelli A, Morena T, Volpe A, Poletti F, Celia A, Zeccolini G, Leonardo C, Proietti F, Finazzi Agrò E, Bove P. The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER'S gangrene: a retrospective multi-institutional cohort study. World J Urol. 2021 Jan;39(1):121-128
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Üroloji
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Burhan Baylan 0000-0002-5509-7140

Recep Uzun 0000-0002-0841-8757

Yayımlanma Tarihi 24 Ekim 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 45 Sayı: 6

Kaynak Göster

Vancouver Baylan B, Uzun R. Fournier Gangreni’nde Vakum Yardımlı Kapama (Vak)’nın Yara İyileşmesi ve Greft Uyumu Üzerine Etkisi. Osmangazi Tıp Dergisi. 2023;45(6):923-7.


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