PURPOSE To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier's gangrene wound therapy. PATIENTS AND METHODS 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. RESULTS 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). CONCLUSIONS 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.

中文翻译：

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真空辅助闭合 (VAC) 疗法在治疗 FOURNIER 坏疽中的作用：一项回顾性多机构队列研究。

目的 探讨真空辅助闭合 (VAC) 治疗与传统敷料在 Fournier 坏疽伤口治疗中的作用。患者和方法 这是一项回顾性多机构队列研究。回顾性分析了 2007 年至 2018 年期间来自 9 个中心的 92 名患者的数据。手术后，局部或播散性 FG 患者接受 VAC 治疗或常规敷料。分析了 10 周伤口闭合累积率和 OS。结果 在 92 名患者中，62 名 (67.4%) 显示局部 FG，30 名 (32.6%) 显示播散性 FG。术后19例（20.7%）局部FG患者和14例（15.2%）播散性FG患者接受VAC治疗；43 例（46.7%）局部性 FG 和 16 例（17.4%）播散性 FG 使用常规敷料治疗。多变量逻辑回归分析表明，播散性 FG 患者的 VAC 导致伤口闭合的累积率高于未接受 VAC 的患者（OR = 6.5；95% CI 1.1-37.4，p = 0.036）。OS 的 Kaplan-Meier 生存曲线显示具有局部和播散性 FG 的无 VAC 患者之间存在显着差异（90 天时的 OS 率分别为 0.90、95% CI 0.71-0.97 vs 0.55、95% CI 0.24-0.78；p = 0.039）。Cox 回归证实，具有播散性 FG 的无 VAC 患者的 OS 最低（根据性别和年龄调整的风险比 HR = 3.4，95% CI 1.1-10.4；p = 0.033）。结论在这项大型队列研究中，对于播散性 FG 患者的 VAC 治疗可能在 10 周伤口闭合累积率和初始手术后 90 天的 OS 方面具有优势。