Treatment of Fournier's gangrene with negative pressure wound therapy in the course of sepsis — Case report

• Published in: International journal of surgery case reports 2023-09, Vol.110, p.108641, Article 108641
• Main Authors: Bes, Mateusz, Chojnacka, Isabella, Szczecińska, Weronika, Zieliński, Jacek
• Format: Article
• Language: English
• Subjects: Alcohol use disorder; Case Report; Fournier's gangrene; Hyperbaric oxygen therapy (HBOT); Negative pressure wound therapy (NPWT); sepsis
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2023.108641

Fournier's Gangrene is a severe and rapidly progressing necrotic infection of the skin and fascia that can affect the external genitals, perineum, anus, and abdomen. It can extend to the abdominal cavity and result in necrosis of the soft tissue with a high mortality rate. This case gives a unique perspective on managing such a complicated infection in a smaller community hospital. This report describes a particularly challenging case of Fournier's Gangrene in a 34 year old male with multiple pre-existing comorbidities, including alcohol use disorder, chronic kidney disease, and hepatitis B. Development of gangrene was preceded by sepsis. The patient's treatment was based on intravenous antibiotic therapy and early surgical intervention with extensive resection of necrotic tissue, supported by Hyperbaric Oxygen Therapy (HBOT) and Negative Pressure Wound Therapy (NPWT). The majority of the patient's treatment was done at a local community hospital with remote coordination with the Hyperbaric Medicine Center where the patient was temporarily transferred to for HBOT. Multiple treatment modalities were employed in this case of Fournier's gangrene, including intravenous antibiotic therapy, necrosectomy, chronic wound care with septic dressings and tissue debridement, HBOT and NPWT. Interdisciplinary cooperation between different medical specialists was crucial in treatment. The presented case shows that despite the large scale of difficulty and the complexity of treatment, it is possible to effectively manage Fournier's Gangrene in a local community hospital through interdisciplinary cooperation with specialized quaternary care centers. HBOT and NPWT proved to be useful treatment modalities. •Hyperbaric Oxygen Therapy and Negative Pressure Wound Therapy are important supporting treatments of Fournier’s Gangrene.•While Fournier’s Gangrene mainly presents on the skin and subcutaneous tissue, it is a multiorgan disease.•It’s possible to manage this disease in a smaller hospital through coordination with specialized quarterly care centers.•Interdisciplinary cooperation between different medical specialists is crucial in treatment.