Med Bull Sisli Etfal Hosp. Kabul Yazýlar: SETB-90757 | DOI: 10.14744/SEMB.2023.90757

Fournier Gangreni tedavisinin tarihinde neler deðiþti: Tek merkez deneyimi

Cemil Kutsal¹, Ýbrahim Halil Baloðlu¹, Nihat Türkmen¹, Taner Hacýosmanoðlu², Ahmet Tevfik Albayrak¹, Ali Emre Çekmece¹, Soner Güney^1
1Saðlýk Bilimleri Üniversitesi Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Üroloji Kliniði, Ýstanbul
²Saðlýk Bilimleri Üniversitesi Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Çocuk Cerrahisi Kliniði, Ýstanbul

Amaç
Fournier Gangreni (FG), acil müdahale gerektiren hýzlý ilerleyen bir enfeksiyondur. Ameliyat
sonrasý yara kapama önemli bir tedavi adýmýdýr ve alternatif bir yara kapama yöntemi olarak
vakum yardýmlý kapama (VAC) tercih edilebilir. Fournier Gangreni Þiddet Ýndeksi (FGSI),
FG'de prognozu deðerlendirmek için geliþtirilebilen ölçeklerden bir tanesidir. Bu çalýþma FG
tedavisinin tarihsel geliþim sürecinde kullanýlan ve geliþtirilen VAC tedavisini, konvansiyonel
yara pansumaný (CWD) ile karþýlaþtýrmayý amaçlamaktadýr.
Yöntemler
Hastanemizde Ocak 2010 Temmuz 2021 tarihleri arasýnda FG tanýsý ile tedavi edilen 85
hastalarýn verileri retrospektif olarak deðerlendirildi. VAC grubunda vakum cihazý sýzdýrmaz
þekilde uygulandý. CWD grubunda yara pansumaný uygulandý. VAC cihazý subatmosferik
basýnca ayarlandý. Tüm hastalara takipleri esnasýnda geniþspektrumlu antibiyoterapi uygulandý.
Takipleri esnasýnda nekrotik dokular tespit edildikçe uygun analjezi ve anestezi saðlanarak re
debridmanlar uygulandý. Hastalarýn demografik verileri kayýtlar üzerinde toplandý. Klinik ve
laboratuar verileri kayýtlar üzerinden elde edilerek 1.saat, 72.saat ve 1. hafta FSGI deðerleri
hesaplandý. Ýstatistiksel analizde; sürekli deðiþkenler ortalama ± standart sapma, sýralý
deðiþkenler medyan [IQR] ve kategorik deðiþkenler n (%) olarak ifade edildi. Gruplar arasý
analizlerde veriler normal daðýlýyorsa student t testi kullanýldý. Normal daðýlým göstermiyorsa
Mann-Whitney U testi uygulandý.
Bulgular
Çalýþmamýza FG tanýsý konulan 55 hasta dahil edildi. 18 hastaya CWD, 37 hastaya VAC
uygulandý VAC kullanan hastalarýn ortalama 1. saat FGSI 7,05 (3,75-8), CWD uygulanan
hastalarýn 5,5 (5-9) (p=0,067). Ortalama 72. saat FGSI VAC grubunda 5,35 (3,5-7), CWD
grubunda 5,33 (4,75-6,25) bulundu (p=0,714). Ortalama 1. hafta FGSI VAC grubu 2,97(1-5),
CWD grubunda 5(4-6) idi (p=0,0001).
Sonuç
VAC, hastanede kalýþ süresini önemli ölçüde azaltýr. Analizimizde, her iki grup da 1. hafta
FGSI'leri arasýnda anlamlý bir fark gözlemledi. Bu, FG tedavisinde kullanýlan VAC tedavisinin
etkisinin temel bir göstergesi olan FGSI' yi deðerlendiren ilk çalýþmadýr. FG tedavisi tarihinde,
geleneksel yara pansumanýnýn yerini VAC almýþtýr. (SETB-2023-01-04)

Anahtar Kelimeler: Fournier Gangreni(FG), geleneksel yara pansumaný (CWD), Vakum yardýmlý kapatma (VAC), Fournier gangreni þiddet indeksi (FGSI), nekrotizan fasiit

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What has changed in the history of Fournier's Gangrene treatment: The single center experience

Cemil Kutsal¹, Ýbrahim Halil Baloðlu¹, Nihat Türkmen¹, Taner Hacýosmanoðlu², Ahmet Tevfik Albayrak¹, Ali Emre Çekmece¹, Soner Güney^1
1Department of Urology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
²Department of Pediatric Surgery, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.

Objectives
Fournier’s Gangrene(FG) is a rapidly progressive infection that requires emergent intervention.
Wound closure is an important treatmentstep aftersurgery, and vacuum-assisted closure (VAC)
can be preferred as an alternative method for wound closure. Fournier’s Gangrene Severity
Index (FGSI), scales that can be developed to evaluate the prognosis in FG. This study aims to
compare VAC therapy, which was used and developed in the historical development of FG
therapy, with conventional wound dressing (CWD).
Methods
Data on who 85 patients treated at our hospital with a diagnosis of FG from January 2010 to
July 2021. In the VAC group, the vacuum device was applied in a sealed manner. In the CWD
group, mesh dressing was prepared. The VAC device was adjusted to subathmospheric
pressure. Broad-spectrum antibiotics were administered to all patients during their follow-up.
During the follow-up, as necrotic tissues were detected, redebridements were performed by
providing appropriate analgesia and anesthesia.
Demographic data of the patients were collected on the records. The clinical and laboratory
data were obtained from the records at the 1st hour 72 hours and 1 st week FSGI values were
calculated. In statistical analysis; continuous variables were expressed as mean ± standard
deviation, ordinal variables were expressed as median [IQR], and categorical variables were
expressed as n (%). In intergroup analyses; student’s t test was used if the data were normally
distributed. If it did not show normal distribution, The Mann- Whitney U test was applied.
Results
Fifty-five patients who were diagnosed with FG were included in our study. CWD was applied
to 18 patients, and VAC was applied to 37 patients The mean 1st hour FGSI of the patients who
used VAC was 7.05 (3.75-8), and the patients who had CWD were 5.5 (5-9) (p=0.067). Mean
72nd-hour FGSI was found to be 5.35 (3.5-7) in the VAC group and 5.33 (4.75-6.25) in the
CWD group (p=0.714). The mean 1st-week FGSI VAC group was 2.97(1-5), and in the CWD
group, it was 5(4-6) (p=0.0001).
Conclusion
VAC significantly reduces the length of hospital stay. In our analysis, both groups observed a
significant difference between the 1st-week FGSIs. This is the first study to evaluate FGSI,
which is an essential predictor of the effect of VAC therapy used in treating FG. In the history
of FG treatment, conventional wound dressing has been replaced by VAC.

Keywords: Fournier’s Gangrene(FG), conventional wound dressing (CWD), Vacuum-assisted closure (VAC), Fournier’s gangrene severity index (FGSI), necrotizing fasciitis

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