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Comparative Study
. 2021 Jan;39(1):121-128.
doi: 10.1007/s00345-020-03170-7. Epub 2020 Mar 31.

The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER'S gangrene: a retrospective multi-institutional cohort study

Valerio Iacovelli  1   2 , Chiara Cipriani  3 , Marco Sandri  4 , Roberta Filippone  5 , Antonella Ferracci  6 , Salvatore Micali  7 , Bernardo Rocco  7 , Stefano Puliatti  7 , Paolo Ferrarese  8 , Giuseppe Benedetto  8 , Andrea Minervini  9 , Andrea Cocci  9 , Antonio Luigi Pastore  10 , Yazan Al Salhi  10 , Alessandro Antonelli  11 , Tonino Morena  11 , Alessandro Volpe  12 , Filippo Poletti  12 , Antonio Celia  13 , Guglielmo Zeccolini  13 , Costantino Leonardo  14 , Flavia Proietti  14 , Enrico Finazzi Agrò  5 , Pierluigi Bove  3
Affiliations
Comparative Study

The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER'S gangrene: a retrospective multi-institutional cohort study

Valerio Iacovelli et al. World J Urol. 2021 Jan.

Abstract

Purpose: To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier's gangrene wound therapy.

Patients and methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Fournier’s gangrene; Necrotizing fasciitis; Overall survival; VAC; Vacuum-assisted closure therapy; Wound therapy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Relative frequency distribution for the number of microorganisms detected in patients with local and disseminated FG
Fig. 2
Fig. 2
Time trends of wound closure cumulative rates in patients with local and disseminated FG managed with VAC or no-VAC therapy
Fig. 3
Fig. 3
Kaplan–Meier survival curves for the overall survival of patients with local and disseminated FG managed with VAC or no-VAC therapy
See this image and copyright information in PMC

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