Presentation Authors: Joshua Palka*, Detroit , MI, William Du Comb, Evan Begun, Omar Soto-Aviles, Detroit, MI
Introduction: Fournier&[prime]s gangrene (FG) is defined as necrotizing fasciitis of the genitalia and perineum. Despite medical advances, FG continues to be a devastating disease with mortality rates up to 50%. Management includes broad-spectrum antibiotics, fluid resuscitation, and aggressive debridement of necrotic tissue. Surgical debridement leads to large soft tissue defects requiring additional treatment modalities. We sought to identify factors and outcomes between patients managed with delayed primary closure (DPC) versus secondary intention (SI).
Methods: All patients who presented to our institution with a diagnosis of FG between 2013 and 2017 were identified. Patients who were less than 18 years old or were transferred from an outside institution were excluded. Retrospective demographic information and clinical data was collected. Quality of life was assessed using the Wound QoL questionnaire, which comprises of 17 questions on a 5-point Likert-type scale.
Results: A total of 37 patients were identified. Demographics other than age were statistically similar (see Table 1). Length of stay and time to intervention were similar between groups (p=0.286 and p=0.081). Wound size was larger in the SI group but this difference was not statistically significant (p=0.347). DPC patients were more likely to undergo secondary and tertiary operations from the initial operation (p = 0.010, p=0.047). DPC patients were also more likely to use additional treatment modalities such as negative pressure dressings (p = 0.045) or utilization of flaps or grafts (p = 0.017). Quality of life was assessed among 44% of living patients. DPC patients were found to have significantly better quality of life scores compared to SI patients (p=0.032).
Conclusions: Patients treated with DPC had smaller wounds that benefited from additional treatment modalities to achieve wound closure after resolution of the active infection. Additionally, DPC patients had better quality of life when compared to patients treated with wound healing by secondary intention. DPC appears to be a safe wound treatment for soft tissue defects amenable to closure after debridement.