Debridement Using the Hydrosurgery System and Negative Pressure Wound Therapy that Allowed Immediate Skin Grafting in a Patient withSevere Fournier's Gangrene

Abstract

[Introduction] Debridement of Fournier's gangrene with an electrosurgical knife is characterized by a lack of swiftness and poor tissue selectivity. The hydrosurgery system (HS) is a new technique utilizing a high-pressure water jet for debridement, but on the other hand, negative pressure wound therapy (NPWT), a wound management technique that accelerates wound healing by maintaining negative pressure at the wound site, has hardly been used in the treatment of Fournier's gangrene for anatomical reasons.

[Case] A 56-year-old man with chief complaints of fever, perineal pain, and impaired consciousness was diagnosed with severe Fournier's gangrene through a physical examination. After debridement with HS, a sigmoid colostomy was performed on the 3rd postoperative day following cardiorespiratory stability. After NPWT for the treatment of a perineal wound, skin grafting was done on the 29th postoperative day. He was discharged in remission on the 48th postoperative day.

[Conclusion] It was possible to perform swift and tissue-selective debridement of Fournier's gangrene through HS. NPWT following HS was safe for wound bed preparation prior to skin grafting, and the patient had a good quality of life during NPWT.