Vacuum-assisted closure device in the postoperative wound care for Fournier's gangrene: a systematic review
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UROLOGY - ORIGINAL PAPER
Vacuum‑assisted closure device in the postoperative wound care for Fournier’s gangrene: a systematic review Daniela Franco‑Buenaventura1,2 · Herney Andrés García‑Perdomo1,2 Received: 27 August 2020 / Accepted: 31 October 2020 © Springer Nature B.V. 2020
Abstract 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. Keywords Fournier gangrene · Negative-pressure wound therapy · Vacuum-assisted closure
Introduction Fournier’s gangrene (FG) is a rare condition first described in 1883 [1]. It is defined as a necrotizing infection that initially affects the perineal region and rapidly spreads along with the fascial layers to external genitals, perianal, and even abdominal zones. The etiology can be divided into urogenital, anorectal, and cutaneous sources. The most frequently affected patients are diabetic, alcoholic, and immunocompromised male patients [2, 3]. The three main principles accepted for the management of Fournier’s Gangrene are initial resuscitation, empirical broad-spectrum antibiotic coverage for Gram-positive, Gram-negative, and anaerobic microorganisms, and early * Herney Andrés García‑Perdomo [email protected] 1
Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia
UROGIV Research Group, Universidad del Valle, Cll 4B, #36‑00 Cali, Colombia
2
aggressive surgical intervention [3, 4]. To accomplish that, the affected patients need a multidisciplinary management at an intermediate or intensive care unit, from urologists, general surgeons, nutritionists, intensive care specialists, and phycologists. The affected patients might need one or more surgical interventions such as wide excision of dead tissues, urinary or gastrointestinal diversio
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