surgeryarticle

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

Iacovelli V, Cipriani C, Sandri M, et al. The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER’S gangrene: a retrospective multi-institutional cohort study. World J Urol. 2021;39(1):121-128. doi:10.1007/s00345-020-03170-7

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 signifcant diference 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 confrmed 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

Summary:

The patient I presented on was found to have Fournier’s Gangrene. After he went to the OR for surgical debridement (x2), they used vacuum assisted closure therapy, so I was interested in looking at the role of this method of closure therapy as compared to conventional practices. This study was a retrospective study which looked at 92 patients who were managed for Fournier’s gangrene with either VAC therapy or conventional dressings. The Multivariable logistic regression analysis showed that at 10 weeks after wound closure, those with disseminated disease treated with VAC had a significantly higher rate of wound closure than those treated with conventional dressings. However, in those with local disease, there was no significant difference in rate of wound closure between the 2 groups. In addition, the overall survival (OS) rate at 90 days after initial surgery was lowest in patients with disseminated disease treated with no-VAC therapy, suggesting that VAC therapy is also significantly helpful in promoting overall survival in these patients, especially those with disseminated disease. Overall, this article demonstrated that VAC therapy is beneficial over traditional therapy in increasing the rate of wound closure and overall survival, especially in disseminated disease.