(CS-112) Case Studies on Fournier’s Gangrene: Rehabilitation Services Integrated Approach to Advanced Wound Healing with use of Negative Pressure Wound Therapy with Instillation and Dwell Time & Safe Patient Handling

Fournier's Gangrene (FG) presents a challenge to the multi-disciplinary team with its emergent nature, surgical complexity, wound healing hurdles, and as an safe patient handling (SPH) conundrum. This case series highlights a multi-specialty wound care collaboration with review of evidence. 

Methods: Three patients were admitted to our hospital between February to June 2022 reporting pain to the perineum and surrounding areas. Patient characteristics were comparable. All received medical/infectious disease specialty follow-ups, active rehabilitation for reconditioning and advanced wound care applications. The surgical team consulted PT wound care specialists to assess for NPWT candidacy and to perform functional assessments alongside Occupational Therapy (OT). P</span>ublished guidelines for Negative Pressure Wound Therapy with Installation and Dwell Time (NPWTi-d) were referenced and this application was tailored to meet wound specific needs. Images and wound measurements were documented for these cases.

Results:

Two cases utilized NPWTi-d with reticulated open cell foam (ROCF) with through holes and saline installation. The third case was managed with standard NPWT. One patient had partial surgical closure during their hospitalization. Wound healing was evidenced in measurements that ranged from 33% to 94% improvement. Proper positioning was achieved with use of SPH devices and the rehab team (PT and OT) was able to progress each patient's functional mobility during their hospital stay. These patients transitioned to sub acute rehab facilities post discharge. All three patients are candidates for reversal of colostomies; initially performed to assist in wound healing.

Discussion:

We present successful integration of the multi-disciplinary approach for patients with complications secondary to Fournier's Gangrene in the acute care setting. Consideration of patient positioning and facilitation of functional mobility along with goals to promote wound healing utilizing advanced technologies like NPWTi-d yielded positive outcomes for all three patients. No current guidelines or algorithm exists for surgical intervention down to post-operative care for FG. This report details a cohesive management plan for future studies.

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