[Management of Fournier gangrene in perineal region by negative-pressure wound therapy combined with delayed repair].

Objective: To explore the effects of negative pressure wound therapy (NPWT) combined with delayed repair on Fournier gangrene in perineal region. Methods: During July 2010 to September 2018, 16 patients with Fournier gangrene in perineal region were admitted to our center, with 13 males and 3 females, aged 30 to 76 years. In the first stage, the necrotic tissue of the wound was completely removed according to the scope of the lesion, and NPWT was applied. After the operation, general anti-infection and nutritional support were performed. In the second stage, the local flaps, free flaps, or skin grafts were chosen to repair the wounds according to the specific condition of wounds. The average length of stay and pathological diagnosis were recorded, and the survival and follow-up of skin grafts and flaps were recorded. Results: All the 16 patients were cured and discharged, with an average of 29.6 days in hospital. The pathological diagnosis of biopsies were necrotizing inflammation. The wound of 1 patient was healed directly after only NPWT, the skin grafts of 5 patients, local flaps of 9 patients, and anterolateral thigh island flap of 1 patient who had NPWT combined with delayed repair survived well. Sixteen patients were followed up for 1 to 2 years after discharge, and no recurrence of Fournier gangrene was found. Among them, 5 patients with wounds involved perineum and scrotum had good appearance and function of scrotum and mons pubis. Conclusions: NPWT combined with delayed plastic repair have great effects on Fournier gangrene.目的： 探讨负压伤口疗法(NPWT)结合延期修复治疗会阴部Fournier坏疽的疗效。 方法： 2010年7月—2018年9月，笔者单位收治16例会阴部Fournier坏疽患者，其中男13例、女3例，年龄30～76岁。Ⅰ期根据病变累及范围彻底清除创面坏死组织后予以NPWT治疗，术后予以全身抗感染及营养支持治疗。Ⅱ期根据创基具体情况选用邻位皮瓣、游离皮瓣及皮片移植的方法修复创面。记录患者平均住院时间、病理诊断结果、皮片和皮瓣存活情况及随访情况。 结果： 16例患者全部治愈出院，平均住院29.6 d，病理诊断均为坏死性炎症。单纯行NPWT治疗的1例患者经治疗后创面直接愈合；NPWT结合延期修复治疗的5例患者中厚皮存活良好，9例患者邻位皮瓣、1例患者股前外侧岛状皮瓣存活良好。16例患者出院后随访1～2年，均未见Fournier坏疽复发，其中5例累及会阴及阴囊的患者阴囊、阴阜外形、功能良好。 结论： NPWT结合延期修复治疗会阴部Fournier坏疽效果较佳。.