Fournier’s gangrene is a rapid and aggressive form of necrotizing fasciitis of the external genitalia. The reported mortality rate varies, but can range as high as 75%. Most patients have such a high mortality rate due to multisystem organ failure that occurs from sepsis. Aggressive surgical debridement needs to be performed. Large tissue deficits for wound healing usually remain on an already compromised body. As a wound care coordinator for a 150-bed hospital in a rural area, this case study is meant to share my experience in the management of this deadly infection and its aftermath of tissue destruction.
Patient B was a 62-year-old male, s/p robotic hernia repair who presented to ER a week later with purulent drainage from midline incision and pain to abdomen radiating to groin. Patient was taken to OR to perform surgical exploration and remove mesh after CT showed evidence of infection. OR findings were infected hematoma and patient was taken to ICU on vent. Patient continually got worse with WBC count climbing, kidney function worsening, and general anasarca worsening. Patient was vented, had CRRT and multiple IV antibiotics, and tube feedings were attempted. I was consulted for moisture-related skin damage to scrotum, and within two days it became necrotic with crepitus. Urology was consulted and patient was taken to OR for aggressive debridement due to necrotizing fasciitis.
VAC Veraflo was initiated within two days as output from wounds was up to 3,000 cc/day.The patient became more stable, tissue granulation occurred rapidly with use of VAC Veraflo, and split-thickness skin grafting was able to occur with 100% adhesion. The patient was discharged to rehab facility healed.
Early recognition, aggressive debridement, and use of VAC Veraflo is key to having a positive outcome for this type of patient, no matter where they may be receiving treatment.