Wound Management Practices in Scrotal-Confined Fournier's Gangrene

To compare real-world outcomes of different wound care strategies following surgical debridement in scrotal-confined Fournier Gangrene (FG), without inferring causality.

Observational study. Place and Duration of the Study: Department of Urology, Aydin Adnan Menderes University, and Ege University, Izmir, Turkiye, from August 2013 to October 2023.

Eighty-six patients with scrotal-confined FG were included. They were divided into three postoperative wound care groups: Group 1 used gauze impregnated with rifampicin and nitrofurantoin, Group 2 used rivanol-impregnated gauze, and Group 3 used vacuum-assisted closure (VAC). Data on demographics, microbial profiles, antibiotic use, and clinical outcomes (including hospital stay) were recorded. Group comparisons were performed using one-way ANOVA, Kruskal-Wallis, or Chi-square tests as appropriate.

The patients' age ranged from 26 to 96 years (mean 63.9 years). The most common single morbidity was diabetes (29.1%). Predominant pathogens were polymicrobial (24.4%) and E. coli (23.3%) in isolation. Overall mortality was 5.8%. Median hospital stays were 9 days (range: 5-28) in Group 1, compared to 14 days (6-40) and 15 days (6-31) in Groups 2 and 3, respectively (p <0.001), with Group 1 being significantly shorter. Secondary debridement rates were similar across groups: 12.5% in Group 1, 37.5% in Group 2, 50% in Group 3 (p = 0.32). Antibiotic choices differed significantly among the groups (p <0.001). Notably, the triple combination regimen of daptomycin, tigecycline, and meropenem was not used in Group 1.

Topical antibiotic dressing using mesh dressings impregnated with rifampicin and nitrofurantoin was associated with a shorter hospitalisation compared to rivanol and VAC therapy in scrotal-confined FG. These findings suggest that rifampicin and nitrofurantoin-based topical therapy may be viable alternatives in resource-limited settings, or where VAC is unavailable.

Fournier gangrene, Wound care, Vacuum-assisted closure, Conventional dressing, Length of hospitalisation.