Fournier Gangreni Tedavisinde Vakum Yardımlı Kapama ve Konvansiyonel Pansumanın Karşılaştırılması

Year 2019, Volume: 14 Issue: 1, 13 - 20, 01.02.2019

Fuat Kızılay , Emir Akıncıoğlu Bülent Semerci Barış Altay

https://doi.org/10.33719/yud.531642

Abstract

Amaç: Bu çalışmada, kliniğimizde, Fourni- er Gangreni nedeniyle cerrahi debridman sonrası Vakum Yardımlı Kapama (VYK) ve konvansiyonel rivanollü pansuman (RP) tedavisi uygulanan hastaların sonuçlarını karşılaştırmayı amaçladık.

Gereç ve Yöntemler: Kliniğimizde Fournier gangreni nedeniyle tedavi edilen 96 hasta, çalışmaya dahil edildi. Hastalar iki gruba ayrıldı; debridman sonrası VYK uygulananlar (Grup A, n=56) ve konvansiyonel RP uygulananlar (Grup B, n=40). Hastaların demografik verileri, hastanede kalış süreleri, ikincil debridman gereklilikleri, nekroz alanı ve lokasyonu, yara iyileşme süreleri, üretral striktür öyküsü, peroperatif kolostomi gereksinimi, perkütan sistostomi gereksinimi, orşiektomi gerekliliği, septik şok varlığı, Fournier gangreni etyolojisi, mortalite oranı ve Fournier Gangreni Şiddet İndeks Skoru karşılaştırıldı. İstatistiksel analizler için Bağımsız Gruplar t-test, Mann-Whitney U test, ki-kare test and Fisher’s exact test kullanıldı. İstatistiksel anlamlılık için 0.05’den küçük p değeri kabul edildi.

Bulgular: VYK uygulanan grupta, hospitalizasyon süresi ve yara iyileşme süresi daha kısaydı (p=0.018 ve p=0.026) ve ikincil debridman gereken hasta sayısı da daha azdı (p=0.011). Multivaryat regresyon analizinde, nekroz alanının büyüklüğü, yara iyileşme süresi, peroperatif kolostomi gereksinimi, septik şok varlığı ve Fournier Gangreni Şiddet İndeks Skoru, mortalite oranını anlamlı olarak etkileyen bağımsız değişkenlerdi.

Sonuç: Fournier gangreni, alternatif tedavi yöntemlerine rağmen, önemli oranda mortalite nedeni olabilen bir hastalıktır. VYK, daha kısa hospitalizasyon süresi ve daha hızlı iyileşme süresi sağlaması nedeniyle, önemli bir postoperatif tedavi ve yara-bakım yöntemidir. 

Keywords

nekrotizan fasiit , fournier gangreni , debridman , negatif-basınçlı yara tedavisi

Comparison of Vacuum Assisted Closure and Conventional Dressing in Fournier Gangrene Treatment

Abstract

Objective: In this study, we aimed to com- pare the outcomes of patients who underwent Vacuum Assisted Closure (VAC) and conventional rivanol dressing (RD) treatment after surgical debridement due to Fournier Gangrene in our clinic.

Materials and Methods: Ninety-six patients treated at our clinic for Fournier Gangrene were included in the study. The patients were divided into two groups; VAC applied patients (Group A, n = 56) and conventional RD applied patients (Group B, n = 40) after debridement. Patient’s demographic data, duration of hospital stay, secondary debridement requirements, necrosis area, and location, wound healing times, urethral stricture history, perioperative colostomy requirement, percutaneous cystostomy requirement, orchiectomy need, septic shock presence, etiology of Fournier Gangrene, mortality rate and Fournier Gangrene Severity Index Score were compared. Independent Groups t-test, Mann-Whitney U test, chi-square test and Fish- er’s exact test were used for statistical analysis. A p value of less than 0.05 was considered for statistical significance.

Results: The duration of hospitalization (days) and wound healing time were shorter (p = 0.018 and p = 0.026) and the number of pa- tients requiring secondary debridement was less (p = 0.011) in the VAC applied group. In the multivariate regression analysis, the size of the necrosis area, wound healing time, perioperative colostomy requirement, the presence of septic shock and Fournier Gangrene Severity Index Score were independent variables that significantly affected the mortality rate.

Conclusions: Fournier Gangrene is a disease that may be a significant cause of mortality despite the alternative treatment methods. VAC is an important postoperative treatment and wound-care method, with a shorter hospitalization period and faster recovery time. 

Keywords

necrotizing fasciitis , fournier gangrene , debridement

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