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Abstract：
OBJECTIVE: To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier\'s gangrene wound therapy.
METHODS: This is a retrospective multi-institutional cohort study. Data of 92 patients from nine centers between 2007 and 2018 were retrospectively analyzed. After surgery, patient having a local or a disseminated FG were managed with VAC therapy or with conventional dressings. The 10-weeks wound closure cumulative rate and OS were analyzed.
RESULTS: Of the 92 patients, 62 (67.4%) showed local and 30 (32.6%) a disseminated FG. After surgery, 19 patients (20.7%) with local and 14 (15.2%) with disseminated FG underwent to VAC therapy; 43 (46.7%) with local and 16 (17.4%) with disseminated FG were treated using conventional dressings. The multivariable logistic regression analysis demonstrated that the VAC in patients with disseminated FG led to a higher cumulative rate of wound closure than patients treated with no-VAC (OR = 6.5; 95% CI 1.1-37.4, p = 0.036). The Kaplan-Meier survival curves for the OS showed a significant difference between no-VAC patients with local and disseminated FG (OS rate at 90 days 0.90, 95% CI 0.71-0.97 vs 0.55, 95% CI 0.24-0.78, respectively; p = 0.039). Cox regression confirmed that no-VAC patients with disseminated FG showed the lowest OS (hazard ratio adjusted for sex and age HR = 3.4, 95% CI 1.1-10.4; p = 0.033).
CONCLUSIONS: In this large cohort study, VAC therapy in patients with disseminated FG may offer an advantage in terms of 10-weeks wound closure cumulative rate and OS at 90 days after initial surgery.
METHODS: This is a retrospective multi-institutional cohort study. Data of 92 patients from nine centers between 2007 and 2018 were retrospectively analyzed. After surgery, patient having a local or a disseminated FG were managed with VAC therapy or with conventional dressings. The 10-weeks wound closure cumulative rate and OS were analyzed.
RESULTS: Of the 92 patients, 62 (67.4%) showed local and 30 (32.6%) a disseminated FG. After surgery, 19 patients (20.7%) with local and 14 (15.2%) with disseminated FG underwent to VAC therapy; 43 (46.7%) with local and 16 (17.4%) with disseminated FG were treated using conventional dressings. The multivariable logistic regression analysis demonstrated that the VAC in patients with disseminated FG led to a higher cumulative rate of wound closure than patients treated with no-VAC (OR = 6.5; 95% CI 1.1-37.4, p = 0.036). The Kaplan-Meier survival curves for the OS showed a significant difference between no-VAC patients with local and disseminated FG (OS rate at 90 days 0.90, 95% CI 0.71-0.97 vs 0.55, 95% CI 0.24-0.78, respectively; p = 0.039). Cox regression confirmed that no-VAC patients with disseminated FG showed the lowest OS (hazard ratio adjusted for sex and age HR = 3.4, 95% CI 1.1-10.4; p = 0.033).
CONCLUSIONS: In this large cohort study, VAC therapy in patients with disseminated FG may offer an advantage in terms of 10-weeks wound closure cumulative rate and OS at 90 days after initial surgery.
摘要：
目的：探讨真空辅助闭合（VAC）疗法与常规敷料在Fournier坏疽伤口治疗中的作用。
方法：这是一项回顾性多机构队列研究。回顾性分析2007年至2018年来自9个中心的92例患者的数据。手术后,患有局部或播散性FG的患者接受VAC治疗或常规敷料治疗.分析10周伤口闭合累积率和OS。
结果：在92例患者中，62(67.4%)显示局部FG，30(32.6%)显示播散FG。手术后,局部19例（20.7％）和播散性FG14例（15.2％）接受VAC治疗；使用常规敷料治疗局部43例（46.7％）和播散性FG16例（17.4％）。多变量逻辑回归分析表明，与无VAC治疗的患者相比，播散性FG患者的VAC导致伤口闭合的累积率更高（OR=6.5；95％CI1.1-37.4，p=0.036）。OS的Kaplan-Meier存活曲线显示，非VAC患者与局部和播散性FG之间存在显着差异（90天的OS率分别为0.90，95％CI0.71-0.97和0.55，95％CI0.24-0.78；p=0.039）。Cox回归证实，无VAC播散性FG患者的OS最低（根据性别和年龄调整的风险比HR=3.4，95％CI1.1-10.4；p=0.033）。
结论：在这项大型队列研究中，播散性FG患者的VAC治疗可能在初次手术后90天的10周伤口闭合累积率和OS方面具有优势。
方法：这是一项回顾性多机构队列研究。回顾性分析2007年至2018年来自9个中心的92例患者的数据。手术后,患有局部或播散性FG的患者接受VAC治疗或常规敷料治疗.分析10周伤口闭合累积率和OS。
结果：在92例患者中，62(67.4%)显示局部FG，30(32.6%)显示播散FG。手术后,局部19例（20.7％）和播散性FG14例（15.2％）接受VAC治疗；使用常规敷料治疗局部43例（46.7％）和播散性FG16例（17.4％）。多变量逻辑回归分析表明，与无VAC治疗的患者相比，播散性FG患者的VAC导致伤口闭合的累积率更高（OR=6.5；95％CI1.1-37.4，p=0.036）。OS的Kaplan-Meier存活曲线显示，非VAC患者与局部和播散性FG之间存在显着差异（90天的OS率分别为0.90，95％CI0.71-0.97和0.55，95％CI0.24-0.78；p=0.039）。Cox回归证实，无VAC播散性FG患者的OS最低（根据性别和年龄调整的风险比HR=3.4，95％CI1.1-10.4；p=0.033）。
结论：在这项大型队列研究中，播散性FG患者的VAC治疗可能在初次手术后90天的10周伤口闭合累积率和OS方面具有优势。
