The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER'S gangrene: a retrospective multi-institutional cohort study.
Fournier’s gangrene
Necrotizing fasciitis
Overall survival
VAC
Vacuum-assisted closure therapy
Wound therapy
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
21
01
2020
accepted:
14
03
2020
pubmed:
3
4
2020
medline:
6
8
2021
entrez:
3
4
2020
Statut:
ppublish
Résumé
To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier's gangrene wound therapy. This is a retrospective multi-institutional cohort study. Data of 92 patients from nine centers between 2007 and 2018 were retrospectively analyzed. After surgery, patient having a local or a disseminated FG were managed with VAC therapy or with conventional dressings. The 10-weeks wound closure cumulative rate and OS were analyzed. Of the 92 patients, 62 (67.4%) showed local and 30 (32.6%) a disseminated FG. After surgery, 19 patients (20.7%) with local and 14 (15.2%) with disseminated FG underwent to VAC therapy; 43 (46.7%) with local and 16 (17.4%) with disseminated FG were treated using conventional dressings. The multivariable logistic regression analysis demonstrated that the VAC in patients with disseminated FG led to a higher cumulative rate of wound closure than patients treated with no-VAC (OR = 6.5; 95% CI 1.1-37.4, p = 0.036). The Kaplan-Meier survival curves for the OS showed a significant difference between no-VAC patients with local and disseminated FG (OS rate at 90 days 0.90, 95% CI 0.71-0.97 vs 0.55, 95% CI 0.24-0.78, respectively; p = 0.039). Cox regression confirmed that no-VAC patients with disseminated FG showed the lowest OS (hazard ratio adjusted for sex and age HR = 3.4, 95% CI 1.1-10.4; p = 0.033). In this large cohort study, VAC therapy in patients with disseminated FG may offer an advantage in terms of 10-weeks wound closure cumulative rate and OS at 90 days after initial surgery.
Identifiants
pubmed: 32236663
doi: 10.1007/s00345-020-03170-7
pii: 10.1007/s00345-020-03170-7
pmc: PMC7223519
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
121-128Références
Fournier JA (1883) Gangrene foudroyante de la verge. Med Pract 4:589–597
Mallikarjuna MN, Vijayakumar A, Patil VS, Shivswamy BS (2012) Fournier's gangrene: current practices. ISRN Surg 2012:942437
doi: 10.5402/2012/942437
Smith GL, Bunker CB, Dinneen MD (1998) Fournier’s gangrene. Br J Urol 81(3):347–355
doi: 10.1046/j.1464-410x.1998.00532.x
Sorensen MD, Krieger JN (2016) Fournier’s gangrene: epidemiology and outcomes in the general US population. Urol Int 97:249
doi: 10.1159/000445695
Stone HH, Martin JD Jr (1972) Synergistic necrotizing cellulitis. Ann Surg 175:702–711
doi: 10.1097/00000658-197205000-00010
Rodríguez Alonso A, Pérez García MD, Núñez López A, Ojea Calvo A, Alonso Rodrigo A, Rodríguez Iglesias B et al (2000) Fournier’s gangrene: anatomo-clinical features in adults and children. Therapy update. Actas Urol Esp 24(4):294–306
doi: 10.1016/S0210-4806(00)72452-1
Eke N (2000) Fournier's gangrene: a review of 1726 cases. Br J Surg 87:718–728
doi: 10.1046/j.1365-2168.2000.01497.x
Chennamsetty A, Khourdaji I, Burks F, Killinger KA (2015) Contemporary diagnosis and management of Fournier's gangrene. Ther Adv Urol 7(4):203–215
doi: 10.1177/1756287215584740
Pastore AL, Palleschi G, Ripoli A, Silvestri L, Leto A, Autieri D et al (2013) 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 7:1
doi: 10.1186/1752-1947-7-1
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
Ozturk E, Ozguc H, Yilmazlar T (2009) The use of vacuum assisted closure therapy in the management of Fournier's gangrene. Am J Surg 197(5):660–665 (discussion 665)
doi: 10.1016/j.amjsurg.2008.04.018
Hagedorn JC, Wessells H (2017) A contemporary update on Fournier's gangrene. Nat Rev Urol 14(4):205–214
doi: 10.1038/nrurol.2016.243
Yanaral F, Balci C, Ozgor F, Simsek A, Onuk O, Aydin M et al (2017) Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier's gangrene. Arch Ital Urol Androl 89(3):208–211
doi: 10.4081/aiua.2017.3.208
Ozkan O, Koksal N, Altinli E, Celik A, Uzun M, Cikman O (2016) Fournier’s gangrene current approaches. Int Wound J 13(5):713–716
doi: 10.1111/iwj.12357
Yücel M, Özpek A, Başak F, Kılıç A, Ünal E, Yüksekdağ S et al (2017) Fournier's gangrene: a retrospective analysis of 25 patients. Ulus Travma Acil Cerrahi Derg 23(5):400–404
pubmed: 29052826
Czymek R, Schmidt A, Eckmann C, Bouchard R, Wulff B, Laubert T et al (2009) Fournier's gangrene: vacuum-assisted closure versus conventional dressings. Am J Surg 197(2):168–176
doi: 10.1016/j.amjsurg.2008.07.053
Korkut M, Içöz G, Dayangaç M, Akgün E, Yeniay L, Erdoğan O et al (2003) Outcome analysis in patients with Fournier's gangrene: report of 45 cases. Dis Colon Rectum 46(5):649–652
doi: 10.1007/s10350-004-6626-x
Assenza M, Cozza V, Sacco E, Clementi I, Tarantino B, Passafiume F et al (2011) VAC (Vacuum Assisted Closure) treatment in Fournier's gangrene: personal experience and literature review. Clin Ter 162(1):e1–5
pubmed: 21448535
Cuccia G, Mucciardi G, Morgia G, Stagno d'Alcontres F, Galì A et al (2009) Vacuum-assisted closure for the treatment of Fournier's gangrene. Urol Int 82(4):426–431
doi: 10.1159/000218532
Saijo S, Kuramoto Y, Yoshinari M (1990) Extremely extended Fournier’s gangrene. Dermatologica 181:228–232
doi: 10.1159/000247930
Oguz A, Gümüş M, Turkoglu A, Bozdağ Z, Ülger BV, Agaçayak E et al (2015) Fournier's gangrene: a summary of 10 years of clinical experience. Int Surg 100(5):934–941
doi: 10.9738/INTSURG-D-15-00036.1
Korhonen K (2000) Hyperbaric oxygen therapy in acute necrotizing infections with a special reference to the effects on tissue gas tensions. Ann Chir Gynaecol 89(suppl):7ff
Pizzorno R, Bonini F, Donelli A (1997) Hyperbaric oxygen therapy in the treatment of Fournier’s disease in 11 male patients. J Urol 158:837–840
doi: 10.1016/S0022-5347(01)64331-3
Capelli-Schellpfeffer M, Gerber GS (1999) The use of hyperbaric oxygen in urology. J Urol 162:647–654
doi: 10.1097/00005392-199909010-00002
Shupak A, Shoshani O, Goldenberg I (1995) Necrotizing fasciitis: an indication for hyperbaric oxygenation therapy? Surgery 118:873–878
doi: 10.1016/S0039-6060(05)80278-8
Wagner S, Greco F, Hoda MR, Kawan F, Heynemann H, Fornara P (2011) Is intensive multimodality therapy the best treatment for fournier gangrene? Evaluation of clinical outcome and survival rate of 41 patients. Surg Infect (Larchmt) 12(5):379–383
doi: 10.1089/sur.2010.091
Lambert KV, Hayes P, McCarthy M (2005) Vacuum assisted closure: a review of development and current applications. Eur J Vasc Endovasc Surg 29:219–226
doi: 10.1016/j.ejvs.2004.12.017