Chang Feng-Shu, Chou Chieh, Hu Chuan-Yu, Huang Shu-Hung
Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Surgery, Faculty of Medicine, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
Plast Reconstr Surg Glob Open. 2018 Jan 25;6(1):e1650. doi: 10.1097/GOX.0000000000001650. eCollection 2018 Jan.
The use of negative-pressure wound therapy (NPWT) for Fournier gangrene management is well documented; however, it is difficult to fixate GranuFoam dressings and maintain an airtight seal over the perineum area. We developed a simple method to facilitate GranuFoam fixation and improve airtight sealing.
The Fournier's gangrene severity index (FGSI) score less than 9 was collected in from January 2015 to October 2016. All 13 patients underwent fasciotomy, and NPWT was applied directly on fasciotomy wounds after the debridement of infected tissue. Partial wound closure was performed, and a portion of GranuFoam was inserted to facilitate fixation. The seal check was converted to a 0-10 scale score that was recorded every 4 hours during NPWT. Patient profiles including medical history, FGSI, method of wound closure, and length of stay were collected in this study.
The median age of the patients was 62 (38-76) years. The mean FGSI score was 4.3 ± 3.1. The average duration of NPWT was 17.5 ± 11.5 days, and the average seal check score was 0.8 ± 0.5. No seal check alarms were noted during the study. Successful wound closure was achieved in all patients without using additional reconstruction methods such as skin grafting or muscle flap coverage.
The present results suggest that partial wound-edge closure and in situ GranuFoam fixation improve the NPWT leaks in Fournier gangrene wounds. Furthermore, this method is simple to learn and can be useful in applying NPWT to anatomically difficult areas.
负压伤口治疗（NPWT）用于福尼尔坏疽的治疗已有充分记载；然而，在会阴区域固定泡沫敷料并保持气密密封很困难。我们开发了一种简单的方法来促进泡沫敷料的固定并改善气密密封。
收集2015年1月至2016年10月福尼尔坏疽严重程度指数（FGSI）评分小于9的患者。所有13例患者均接受了筋膜切开术，在清除感染组织后直接在筋膜切开伤口上应用NPWT。进行部分伤口闭合，并插入一部分泡沫敷料以促进固定。密封检查转换为0至10分制评分，在NPWT期间每4小时记录一次。本研究收集了患者的病历资料，包括病史、FGSI、伤口闭合方法和住院时间。
患者的中位年龄为62岁（38 - 76岁）。平均FGSI评分为4.3±3.1。NPWT的平均持续时间为17.5±11.5天，平均密封检查评分为0.8±0.5。研究期间未发现密封检查警报。所有患者均成功实现伤口闭合，无需使用额外的重建方法，如植皮或肌皮瓣覆盖。
目前的结果表明，部分伤口边缘闭合和原位泡沫敷料固定可改善福尼尔坏疽伤口的NPWT渗漏。此外，该方法易于学习，在将NPWT应用于解剖结构复杂的区域时可能有用。
