Combining Flexi-Seal and negative pressure wound therapy for wound management in Fournier's gangrene.

Dear Editors, Fournier’s gangrene is a fast progressing, life-threatening necrotizing infection, which is commonly seen in the dermis and subcutaneous layers of the anogenital region. The infection is usually caused by organisms that spread along the subcutaneous and fascial planes across the perineum, scrotum and often beyond these tissues. The usual treatment is a prompt surgical debridement and, in many cases, a diverting colostomy (1,2). Here, we present a Fournier’s gangrene case, where a combined treatment with the Flexi-Seal Faecal Management System (1) and a negative pressure wound therapy (NPWT) were used to achieve optimal results. Presented case was a 43-year old, female patient, with a body mass index of 38. She was first seen in the emergency unit with a large wound in the gluteal region and high fever. She had been diabetic for at least 5 years. There was also a history of abdominal hernia operation. An extensive necrosis was noted between right gluteal region and labium major. The necrosis was continuing to the femoral canal. The subcutaneous tissues and the deep fascia were also involved. The proximity to anal canal was about 3 cm (Figure 1A). A giant ventral hernia was noted, although we were not sure if it was related to the present problem. The clinical diagnosis of the wound was sepsis associated with Fournier’s gangrene. An immediate surgical debridement was planned and performed. As medical treatment, ceftriaxone and metronidazole were used. At the end of the debridement, a Flexi-Seal Faecal Management System