Suture Technique to Prevent Air Leakage during Negative-Pressure Wound Therapy in Fournier Gangrene

Background: The use of negative-pressure wound therapy (NPWT) for Fournier gangrene management is well documented; however, it is difficult to fixate GranuFoam dressings and maintain an airtight seal over the perineum area. We developed a simple method to facilitate GranuFoam fixation and improve airtight sealing. Methods: The Fournier's gangrene severity index (FGSI) score less than 9 was collected in from January 2015 to October 2016. All 13 patients underwent fasciotomy, and NPWT was applied directly on fasciotomy wounds after the debridement of infected tissue. Partial wound closure was performed, and a portion of GranuFoam was inserted to facilitate fixation. The seal check was converted to a 0–10 scale score that was recorded every 4 hours during NPWT. Patient profiles including medical history, FGSI, method of wound closure, and length of stay were collected in this study. Results: The median age of the patients was 62 (38–76) years. The mean FGSI score was 4.3 ± 3.1. The average duration of NPWT was 17.5 ± 11.5 days, and the average seal check score was 0.8 ± 0.5. No seal check alarms were noted during the study. Successful wound closure was achieved in all patients without using additional reconstruction methods such as skin grafting or muscle flap coverage. Conclusions: The present results suggest that partial wound-edge closure and in situ GranuFoam fixation improve the NPWT leaks in Fournier gangrene wounds. Furthermore, this method is simple to learn and can be useful in applying NPWT to anatomically difficult areas. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Published online 25 January 2017. Received for publication September 5, 2017; accepted December 4, 2017. Supported by grants from the Ministry of Science and Technology of Taiwan (MOST 104-2314-B-037-061-MY3); Kaohsiung Medical University Hospital (KMUH105-5R69). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Shu-Hung Huang, MD, PhD, Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, 100 Tzyou 1st Rd., Kaohsiung 80708, Taiwan, E-mail: huangsh63@gmail.com Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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