Managing extensive Fournier's gangrene secondary to bilateral, inguinal hernias

Vacuum-assisted closure device in the postoperative wound care for Fournier's gangrene: a systematic review

PURPOSE

To determine the effectiveness of Vacuum-Assisted Closure Device in the postoperative wound care for Fournier's gangrene METHODS: We performed a systematic review in the following databases: Medline (Ovid), EMBASE, and The Cochrane Central Register of Controlled Trials (CENTRAL), from inception to nowadays. We included RCTs and analytical observational studies. Meta-analysis was not possible given the clinical and methodological heterogeneity of the studies.

RESULTS

We included six studies that compared VAC treated patients and a control group. The length of stay of the VAC treated vs. the conventional dressing treated patients was higher for the VAC treated patients in all but one of the included studies. The VAC group had the highest number of surgical debridements requiring anesthesia. The conventionally treated patients had a higher number of daily dressings, and the need for additional dressing changes, without anesthesia. Two studies found significantly higher mean scores for VAS, requiring a higher need for daily analgesics for the control group patients.

CONCLUSIONS

VAC therapy is an effective method, but it is not better than conventional dressing treatment. VAC carries fewer dressing changes, less pain, and less need for analgesics, but it comes with a higher need for surgical interventions requiring anesthesia.

Fournier's Gangrene as a Postoperative Complication of Inguinal Hernia Repair

Fournier's gangrene is the necrotizing fasciitis of perianal, genitourinary, and perineal regions. Herein, we present a case of scrotal Fournier's gangrene as a postoperative complication of inguinal hernia repair. A 51-year-old male with giant indirect hernia is presented. Patient underwent inguinal hernia repair, and after an unproblematic recovery period, he was discharged. He applied to our outpatient clinic on the fifth day with swollen and painful scrotum and it turned out to be Fournier's gangrene. Polypropylene mesh was not infected. Patient recovered and was discharged after repeated debridements. Basic principles in treatment of Fournier's gangrene are comprised of initial resuscitation, broad-spectrum antibiotics therapy, and early aggressive debridement. In the management of presented case, aggressive debridement was made right after diagnosis and broad-spectrum antibiotics were given to the hemodynamically stable patient. In these circumstances, the important question is whether we could prevent occurrence of Fournier's gangrene.