Fournier Gangreni’nde Vakum Yardımlı Kapama (Vak)’nın Yara İyileşmesi ve Greft Uyumu Üzerine Etkisi

Giriş: Fournier Gangreni (FG), perineal, perianal veya genital bölgeleri etkileyen agresif bir nekrotizan fasiit olarak tanımlanmıştır. FG’de nekrotik dokuların erken dönemde agresif ve tam cerrahi debridmanı yapılmalıdır. FG'nin tedavisinde VAK ve konvansiyonel pansumanu karşılaştırarak, başlangıç cerrahisi ile greftleme arasında geçen süre ve greftleme sonrası sekonder debritman gereksinimi açısından incelemeyi amaçladık. Materyal-Metod: 2015- 2023 yılları arasında Üroloji Kliniği’mizce FG tanısı konularak cerrahi tedavi uygulanan ve greft ile doku kapama yapılmış 48 hastanın verileri retrospektif incelendi. Hastaların klinik, patofizyolojik özellikleri, predispozan faktörler, VAK veya konvansiyonel pansuman kullanımı, greft kaybı sayıları, hastanede kalış süreleri kaydedildi. VAK ve konvansiyel pansuman yapılan gruplar karşılaştırılmalı değerlendirildi. Bulgular: Fournier Gangreni tanısı ile takip ve tedavi edilen toplam 48 hastanın 25’inde (%52) postoperatif dönemde VAK pansuman kullanılırken, 23’ünde (%48) konvansiyonel pansuman kullanılmıştı. Ortalama hastanede yatış süreleri, VAK grubunda 28 gün , konvansiyonel grupta 48 gün olarak tespit edilmiş ve VAK grubunda anlamlı olarak daha kısa saptandı. (p = 0.008). VAK grubunda 2 hastada , konvansiyonel pansuman yapılan hasta grubunda 6 hastada greft ile kapama sonrası sekonder debritman gerekli olduğu tespit edildi.Greft kaybı oranları VAK pansuman yapılan grupta, konvansiyonel pansuman yapılan gruba göre istatistiksel anlamlı daha azdı. Sonuç: FG ‘de VAK tedavisi yara iyileştirmesini hızlandırmakta, hastanede kalış süresini kısaltmakta ve greft ile doku kapama sonrası ikincil cerrahi girişim oranlarını azaltmaktadır

Anahtar Kelimeler:

Fournier gangreni, VAK, konvansiyonel pansuman, greft

The Effect of Vacuum-Assited Closure (VAC) on Wound and Graft Healing in Fournier’s Gangrene

Fournier's Gangrene (FG) has been described as an aggressive necrotizing fasciitis that affects the perineal, perianal, or genital areas. Aggressive and complete surgical debridement of necrotic tissues should be performed in the early period in FG. We aimed to compare VAC and conventional dressing in the treatment of FG in terms of the time elapsed between initial surgery and grafting and the need for secondary debridement after grafting. The data of 48 patients who were diagnosed with FG by our Urology Clinic between 2015 and 2023, underwent surgical treatment and graft tissue closure were retrospectively analyzed. Clinical, pathophysiological features, predisposing factors, use of VAC or conventional dressings, number of graft losses, length of hospital stay were recorded. VAC and conventional groups were evaluated comparatively Of the total 48 patients who were followed up and treated with Fournier's Gangrene, 25 (52%) used VAK dressing in the postoperative period, while conventional dressing was used in 23 (48%). The mean length of hospital stay was 28 days in the VAC group, 48 days in the conventional group and significantly shorter in the VAC group. (p = 0.017). It was determined that secondary debridement was required after graft closure in 2 patients in the VAK group and in 6 patients in the conventional dressing group. Graft loss rates were statistically significantly less in the VAC dressing group than in the conventional dressing group. VAC treatment in FG accelerates wound healing, shortens hospital stay, and reduces secondary surgical intervention rates after tissue closure with grafting.

Keywords:

Fournier, VAC, conventional dressing, graft,

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