Principles of dressing and debridement in modern rural surgery: experience of a case of Fournier’s gangrene

Authors

  • Arijit Rumu Baruah Department of Surgery, Jorhat Medical College and Hospital, Jorhat, Assam, India https://orcid.org/0000-0002-5631-4100
  • Darpana Kalita Department of Radiodiagnosis, Jorhat Medical College and Hospital, Jorhat, Assam, India

DOI:

https://doi.org/10.18203/2349-2902.isj20240763

Keywords:

Necrotising, Fasciitis, Obliterative, Endarteritis, Dressing, Debridement

Abstract

Fournier’s gangrene is a rare and rapidly progressive necrotising fasciitis of the external genitalia and perineum. It is characterised by obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the subcutaneous tissue and the overlying skin. Rural surgery refers to the practice of surgery serving people in rural communities and geographically remote areas. Rural surgery faces multiple challenges like limitation of resources and manpower, poverty, multiple co-morbidities and superstitions. We present such a case of Fournier’s gangrene treated in a secondary care centre of rural Assam. A 45 year old male presented with pain and discharge from the scrotum since two weeks. No other co-morbidities were present. Initially, wound debridement and dressing with hydrogen peroxide and povidone iodine is done. Necrosed tissue is sent for microbial culture and sensitivity. Initially, empirical antibiotics was started and was converted to fluoroquinolones as it showed sensitivity. Serial dressing and debridement were continued till healthy granulation tissue appeared. Then, the wound was closed by loose approximation method. Wound was successfully apposed and viability of both the testis was also found to be intact. Thus, the age-old principle of dressing and debridement still serves as the background of wound care in modern rural surgery.

References

Liguori G, Ollandini G, Napoli R, Mazzon G, Petrovic M, Trombetta C. Anatomy of the Scrotum. Scrotal Pathol. 2012;27-34.

Benjelloun EB, Souiki T, Yakla N, Ousadden A, Mazaz K, Louchi A, et al. Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality. World J Emergency Surg. 2013;8:1-5.

Kara E, Müezzinoglu T, Temeltas G, Dinçer L, Kaya Y, Sakarya A, et al. Evaluation of risk factors and severity of a life threatening surgical emergency: Fournier’s gangrene (a report of 15 cases). Acta Chirurgica Belgica. 2009;109(2):191-7.

Bozkurt O, Sen V, Demir O, Esen A. Evaluation of the utility of different scoring systems (FGSI, LRINEC and NLR) in the management of Fournier’s gangrene. Int Urol Nephrol. 2015;47:243-8.

Anderson I. Debridement methods in wound care. Nursing Standard. 2006;20(24):65-70.

Sparenborg JD, Brems JA, Wood AM, Hwang JJ, Venkatesan K. Fournier’s gangrene: a modern analysis of predictors of outcomes. Translational Androl Urol. 2019;8(4):374.

Nakayama DK, Hughes TG. Issues that face rural surgery in the United States. J Am College Surg. 2014;219(4):814-8.

Shyam DC, Rapsang AG. Fournier's gangrene. The Surgeon. 2013;11(4):222-32.

Ozkan OF, Koksal N, Altinli E, Celik A, Uzun MA, Cıkman O, et al. Fournier's gangrene current approaches. Int Wound J. 2016;13(5):713-6.

Altomare M, Benuzzi L, Molteni M, Virdis F, Spota A, Cioffi SP, et al. Negative Pressure Wound Therapy for the Treatment of Fournier’s Gangrene: A Rare Case with Rectal Fistula and Systematic Review of the Literature. J Personalized Med. 2022;12(10):1695.

Agwu NP, Muhammad AS, Abdullahi AA, Bashir B, Legbo JN, Mungadi IA. Pattern and outcome of management of Fournier's gangrene in a resource-constraint setting. Urol Ann. 2020;12(3):248.

Huayllani MT, Cheema AS, McGuire MJ, Janis JE. Practical review of the current management of Fournier’s gangrene. Plastic Reconstructive Surg Global Open. 2022;10(3).

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Published

2024-03-27

Issue

Section

Case Reports