%0 Comparative Study
%T The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER'S gangrene: a retrospective multi-institutional cohort study.
%A Iacovelli V
%A Cipriani C
%A Sandri M
%A Filippone R
%A Ferracci A
%A Micali S
%A Rocco B
%A Puliatti S
%A Ferrarese P
%A Benedetto G
%A Minervini A
%A Cocci A
%A Pastore AL
%A Al Salhi Y
%A Antonelli A
%A Morena T
%A Volpe A
%A Poletti F
%A Celia A
%A Zeccolini G
%A Leonardo C
%A Proietti F
%A Finazzi Agrò E
%A Bove P
%J World J Urol
%V 39
%N 1
%D Jan 2021
%M 32236663
%F 3.661
%R 10.1007/s00345-020-03170-7
%X <B>OBJECTIVE: </B>To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier's gangrene wound therapy.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.