University of Iowa, Carver College of Medicine, Department of Urology, Iowa City, IA.
University of Iowa, College of Public Health, Department of Biostatistics, Iowa City, IA.
Urology. 2022 Aug;166:250-256. doi: 10.1016/j.urology.2022.03.042. Epub 2022 May 16.
To evaluate the efficacy of early necrotizing soft-tissue infections of the genitalia (NSTIG) component separation, primary wound closure (CSC). We hypothesized that early CSC would be safe, decrease the need for split-thickness skin grafting (STSG) and decrease wound convalescence time.
MATERIALS/METHODS: Management of consecutive NSTIG patients from a single institution were evaluated. Three cohorts emerged: 1) those managed/closed by a reconstructive urologist (URO) using CSC principles (wide genital tissue mobilization with primary closure, when possible, +/- STSG), 2) those managed/closed by the general surgery/burn service, and 3) those managed conservatively with secondary closure. Total NSTIG anatomic extent (AE) was determined by assessing involvement of the penis, scrotum, perineum and suprapubic region, and ranged from 1 (<50% involvement of one area) to 8 (>50% involvement in all 4 areas).
Of 84 FG patients meeting study criteria, 48 (57%) were closed primarily and 36 were left to heal by secondary intention. AE was greatest in patients managed by general surgery/burn service (4.5 ± 1.5), followed by URO (2.7 ± 1.8) and secondary intention cases (1.3 ± 0.5). Secondary procedure rates were similar between closure/non-closure cohorts (6.3% v 11%; P = 0.67). STSG use was predicted by wound size (though not time to closure)-specifically with suprapubic and/or penile wounds of >50% involvement. Wound convalescence time decreased by 64% when wounds were closed versus left open, controlling for AE.
Early, same-admission primary closure of stable NSTIG wounds is safe and decreases wound convalescence time by over 60%.
评估生殖器早期坏死性软组织感染（NSTIG）分离、一期创面闭合（CSC）的疗效。我们假设早期 CSC 是安全的，可减少需要进行中厚皮片游离移植（STSG），并减少创面康复时间。
材料/方法：评估单机构连续 NSTIG 患者的治疗情况。出现了三个队列：1）由泌尿科重建医师（URO）使用 CSC 原则进行治疗/闭合（广泛的生殖器组织移动，尽可能进行一期闭合，加/- STSG）的患者，2）由普通外科/烧伤科治疗/闭合的患者，3）接受保守治疗行二期闭合的患者。总 NSTIG 解剖范围（AE）通过评估阴茎、阴囊、会阴和耻骨上区域的受累程度来确定，范围从 1（一个区域受累<50%）到 8（所有 4 个区域受累>50%）。
符合研究标准的 84 例 FG 患者中，48 例（57%）被一期闭合，36 例因中厚皮片游离移植而遗留创面未愈合。普通外科/烧伤科治疗的患者 AE 最大（4.5±1.5），其次是 URO 治疗的患者（2.7±1.8）和接受二期闭合的患者（1.3±0.5）。闭合/未闭合患者组的二期手术率相似（6.3%比 11%；P=0.67）。尽管时间到闭合时间不一，但 STSG 的使用取决于创面大小，尤其是耻骨上和/或阴茎受累>50%的创面。与未闭合相比，一期闭合可使创面康复时间缩短 64%，但 AE 则相反。
对于稳定的 NSTIG 伤口，早期、同一住院日进行一期闭合是安全的，可使创面康复时间缩短 60%以上。
