Curative treatment without surgical reconstruction after perineal debridement of Fournier's gangrene.

BACKGROUND: Fournier's gangrene (necrotizing fasciitis) is an acute life-threatening disease of the perineal area that requires urgent medical intervention. Once the affected area is surgically debrided and the patient is stabilized, surgical management typically involves 1 or more additional procedures that may include split-thickness skin grafts, flaps, or an elective diverting urostomy and/or colostomy. The professional literature discussing nonsurgical approaches to healing for Fournier's gangrene after surgical debridement is sparse. CASE: We present 3 cases of male patients with Fournier's gangrene from our facility who healed uneventfully with negative pressure wound therapy placed after extensive debridement without further surgical intervention. An added benefit was a satisfactory aesthetic effect. CONCLUSION: Expert wound management including negative pressure wound therapy after surgical debridement of Fournier's gangrene eliminated the need for further operative procedures and prolonged hospitalizations in these cases. We believe that surgical teams should consider using negative pressure wound therapy as part of the initial curative plan of care after debridement, and that plans for restorative plastic surgery should be restricted to patients who do not exhibit adequate improvement with conservative wound management.

Recognizing hospital-acquired burn injury in patients after coronary artery bypass surgery.

BACKGROUND: Nosocomial injury is a constant threat in the hospital setting. While there is growing awareness surrounding hospital-acquired pressure ulcers, little information is available on burns associated with intraoperative procedures. CASES: We identified perineal lesions on 4 patients who underwent coronary artery bypass with grafting. These injuries were initially classified as pressure ulcers but subsequent investigation revealed that the injuries were intraoperative burns attributable to pooling of isopropyl alcohol underneath patients who were placed on intraoperative heating pads. CONCLUSIONS: Differentiating between hospital-acquired pressure ulcers and burns can be difficult. Our facility's experience with intraoperative burn injuries now mandates that this etiologic factor be considered in the differential diagnosis of postoperative patients with atypical cutaneous injuries.