Comparison of Conventional Wet Dressing and Vacuum Assisted Closure with Hypochlorous Acid Application in Fournier Gangrene Treatment

Öz

Background: Bacterial toxins cause local tissue damage and necrosis. This can continue until a significant amount of tissue becomes necrotic. Neutralization of bacterial toxins improves results. Low concentrations of Hypochlorous Acid can be antimicrobial without causing cytotoxicity in normal cells in the wound and surrounding tissues. In this study, we aimed to compare the results of patients treated with hypochlorous acid (0.01% w/v) through Vacuum Assisted Closure and with traditional wet dressing after surgical debridement due to Fournier Gangrene in our clinic. Materials and Methods: 73 patients treated for Fournier Gangrene between 2009-2019 in our clinic were evaluated retrospectively. The patients were divided into two groups: those who received Hypochlorous Acid with Vacuum Assisted Closure (Group A, n = 30) and those who received traditional wet dressing (Group B, n = 42) after the first debridement. Hypochlorous Acid (0.01% w/v), known to destroy bacteria and bacterial toxins, was administered to 30 patients with Fournier Gangrene in saline with a pH of 4-5, 5-6 times a day. Using Vacuum Assisted Closure, 5-10 ml of 0.01% Hypochlorous Acid was applied to the wound and aspirated. For wet dressing application, the wound was closed by applying mupirocin calcium and rifamycin to an appropriate number of wet sponges suitable for the wound surface and depth after cleansing the wound with sponges moistened with isotonic 3 times a day. The collected data were compared. P values smaller than 0.05 were considered significant. Results: The hospitalization time and wound healing time of 30 patients who received Hypochlorous Acid with Vacuum Assisted Closure were shorter (p <0.05), and the number of patients requiring secondary debridement was also lower (p <0.05). Conclusion: Hypochlorous Acid application with Vacuum Assisted Closure is an effective, successful and important postoperative treatment and wound care method that provides shorter hospital stay and faster recovery time. Toxicity and immune dysfunction due to bacterial toxins and toxins released from damaged cells can be alleviated with 0.01 Hypochlorous Acid application via Vacuum Assisted Closure. We recommend this method, which is easy to apply and inexpensive in certain Fournier Gangrene cases.

Anahtar Kelimeler

• Hypochlorous Acid
• Negative-Pressure Wound Therapy
• Fournier Gangrene

Fournier Gangreni Tedavisinde Geleneksel Islak Pansuman’ın ve Vakum Destekli Kapatma eşliğinde Hipoklorik Asit Uygulamasının Karşılaştırılması

Öz

Amaç: Bakteriyel toksinler, lokal doku hasarına ve nekroza neden olur. Önemli miktarda doku nekrotik hale gelene kadar bu devam edebilir. Bakteriyel toksinlerin nötralizasyonu sonuçları iyileştirmektedir. Hipoklorik asit’in düşük konsantrasyonları, yaradaki ve çevre dokulardaki normal hücrelerde sitotoksisiteye neden olmadan antimikrobiyal etkili olabilmektedir. Fournier Gangreni gelişen hastalarda, yapılan operasyon sonrası uygulanan Vakum Destekli Kapatma eşliğinde yaraya hipoklorik asit (% 0.01 w/v) uygulaması ile geleneksel ıslak pansuman tedavisi uygulanan hastaların sonuçlarını karşılaştırmayı amaçlayan bir çalışma hazırladık. Materyal ve Metod: Merkezimizde 2009-2019 yılları arasında Fournier Gangreni nedeniyle debridman uygulanan 73 hasta retrospektif olarak değerlendirdi. İki grup halinde ele alındılar; debridmandan sonra Vakum Destekli Kapatma ile Hipoklorik asit uygulananlar (A Grubu, n =30) ve geleneksel ıslak pansuman uygulananlar (Grup B, n = 42). Bakterileri ve bakteriyel toksinleri yok ettiği bilinen Hipoklorik asit (% 0.01 w/v), pH’ı 4-5 olan salin içinde Fournier Gangreni’li 30 hastaya günde 5-6 kez uygulandı. Vakum Destekli Kapatma kullanılarak 5-10 ml % 0.01 Hipoklorik asit yaraya uygulanıp aspire edildi. Islak pansuman uygulamasında ise günde 3 kez, izotonik ile ıslatılan spançlarla yara temizlendikten sonra yara yüzeyine ve derinliğine uygun sayıdaki ıslak spançlara mupirosin kalsiyum ve rifamisin uygulanarak yara kapatıldı. Toplanan veriler karşılaştırıldı. Anlamlılık için 0.05’ten küçük p değeri kabul edildi. Bulgular: Vakum Destekli Kapatma ile Hipoklorik asit uygulanan 30 hastanın hastanede yatış süresi ve yara iyileşme süresi daha kısaydı (p= 0.018) ve ikincil debridman gereken hasta sayısı da daha düşüktü (p = 0.026). Sonuç: Vakum Destekli Kapatma ile Hipoklorik asit uygulaması, daha kısa hastanede yatış süresi ve daha hızlı iyileşme süresi sağlayan etkili, ameliyat sonrası için başarılı bir yara tedavi yöntemidir. Bakteri kaynaklı ve zarar gören hücrelerden salınan toksinler nedeniyle ortaya çıkan toksisite ve immun işlevsizlik Vakum Destekli Kapatma eşliğinde 0.01 Hipoklorik asit uygulaması ile hafifletilebilir. Uygun Fournier Gangreni vakalarında kolay uygulanabilir ve ucuz olan bu yöntemi öneriyoruz.

Anahtar Kelimeler

• Hipoklorik Asit Hipokloröz Asit
• Negatif-Basınçlı Yara Terapisi
• Fornier Gangreni

Kaynakça

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