Favorable Outcomes With Early Component Separation, Primary Closure of Necrotizing Soft Tissue Infections of the Genitalia (Fournier's Gangrene) Debridement Wound Defects

• Published in: Urology (Ridgewood, N.J.) N.J.), 2022-08, Vol.166, p.250-256
• Main Authors: Sandberg, Jason M., Warner, Hayden L., Flynn, Kevin J., Sexton, Shawn M., Pham, Hanh TD, Kandler, Blaize W., Polgreen, Phillip M., Erickson, Bradley A.
• Format: Article
• Language: English
• Subjects: Convalescence; Debridement - methods; Fournier Gangrene - surgery; Humans; Male; Scrotum - surgery; Soft Tissue Infections - complications; Soft Tissue Infections - surgery; Wound Closure Techniques; Wound Healing
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2022.03.042

To evaluate the efficacy of early necrotizing soft-tissue infections of the genitalia (NSTIG) component separation, primary wound closure (CSC). We hypothesized that early CSC would be safe, decrease the need for split-thickness skin grafting (STSG) and decrease wound convalescence time. Management of consecutive NSTIG patients from a single institution were evaluated. Three cohorts emerged: 1) those managed/closed by a reconstructive urologist (URO) using CSC principles (wide genital tissue mobilization with primary closure, when possible, +/- STSG), 2) those managed/closed by the general surgery/burn service, and 3) those managed conservatively with secondary closure. Total NSTIG anatomic extent (AE) was determined by assessing involvement of the penis, scrotum, perineum and suprapubic region, and ranged from 1 (50% involvement in all 4 areas). Of 84 FG patients meeting study criteria, 48 (57%) were closed primarily and 36 were left to heal by secondary intention. AE was greatest in patients managed by general surgery/burn service (4.5 ± 1.5), followed by URO (2.7 ± 1.8) and secondary intention cases (1.3 ± 0.5). Secondary procedure rates were similar between closure/non-closure cohorts (6.3% v 11%; P = 0.67). STSG use was predicted by wound size (though not time to closure)-specifically with suprapubic and/or penile wounds of >50% involvement. Wound convalescence time decreased by 64% when wounds were closed versus left open, controlling for AE. Early, same-admission primary closure of stable NSTIG wounds is safe and decreases wound convalescence time by over 60%.