Fournier's Gangrene: Our Five-Year Series and the Role of Vacuum-Assisted Closure in the Treatment.

BACKGROUND: Fournier's Gangrene (FG) is the necrotizing fasciitis of the perineal region. AIMS: To compare the effectiveness of debridement alone and debridement with vacuum-assisted closure in the treatment of Fournier's gangrene. METHODS: Twenty-two patients operated for FG were analyzed retrospectively. Debridement-only and debridement + VAC treatment groups were compared in terms of age, gender, predisposing factors, comorbid diseases, intensive care unit and hospital stay durations, laboratory results, septic shock, treatment methods, Fournier' gangrene severity index (FGSI) and mortality. RESULTS: The M/F ratio was 13/9. There were 10 and 12 patients in debridement-only and debridement + VAC groups, respectively. Ten patients (45.5%) were admitted to intensive care unit, 8 (36.4%) needed colostomy and 7 (31.9%) developed septic shock, respectively. The mortality rate was 27.3%. There was no significant difference in terms of age, gender, laboratory parameters, number of debridement, length of stay in intensive care unit and hospital, shock duration, and mortality (P > 0.05). The FGSI scores also did not show any difference between the groups which showed that the severity of the disease in both groups are similar. CONCLUSION: The VAC treatment was found not to provide a statistically significant benefit on mortality. Early and adequate debridement and antibiotic are still the most important factors in the treatment of FG and to reduce mortality.

THYROID SURGERY, IONM AND SUGAMMADEX SODIUM RELATIONSHIPS: BENEFITS IN SUGAMMADEX SODIUM USE FOR IONM.

BACKGROUND: It is important to protect recurrent laryngeal nerve (RLN) during thyroid surgery. Thus, intra- operative neuromonitoring (IONM) has got popularity. But, the half life of neuromuscular blocking agents used has a reverse correlation with reliability and effectiveness of IONM. This study aimed to research the effect of Sugammadex Sodium, a specific nemuromuscular blocking agent antagonist, on nerve conduction and IONM. MATERIALS AND METHODS: Twenty patients who underwent thyroidectomy under IONM followed an enhanced NMB recovery protocol-rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at the beginning of operation. To prevent laryngeal nerve injury during the surgical procedures, all patients underwent intraoperative monitoring. At the same time, the measurement of TOF-Watch acceleromyograph of the adductor pollicis muscle response to ulnar nerve stimulation was performed; recovery was defined as a train-of-four (TOF) ratio ≥ 0.9. Age, sex, recurrent laryngeal nerve transmission speeds prior to and after operation, BMI, duration of surgery, the change in nerve transmission after drug administration and complications were analyzed. RESULTS: The mean age and the mean BMI were 47.6±11.82 years and 28.74±3.20, respectively. The mean operation duration was 52.65±5.51 minutes. There was no difference in either right or left RLN monitoring values before and after surgery. Following the drug injection, the TOF guard measurements on the 1st, 2nd, 3rd and 4th minutes were 23.5±4.90; 69.5±6.86; 88±4.1 and 135.9±10.62, respectively. CONCLUSION: Neuromuscular blocking antagonist use and monitoring nerve transmission speed with TOF-guard can provide a safer resection.