Analysis Of The Clinical Effect Of VSD Technique In The Treatment Of Scrotal Gangrene

[Background & objective]: Gangrene of scrotum,also known as Fournier gangrene,is a rare but serious acute necrotizing fasciitis of scrotum subcutaneous tissue.The onset of this disease is urgent and dangerous.It often dies of delayed diagnosis and treatment,severe infection,shock and even multiple organ failure.VSD,or vacuum sealing drainage,is a new and efficient wound drainage technology,which is mainly used in orthopedics,burn department and general surgery to deal with complex wounds.It is rarely used in the treatment of scrotal gangrene and rarely used by urologists.In order to provide reference for the clinical treatment of scrotal gangrene,the clinical effect of VSD was observed.[Method]: From August 2017 to December 2019,10 patients diagnosed as gangrene or necrotizing fasciitis of scrotum in Quanzhou First Hospital Affiliated to Fujian Medical University of our hospital were selected in this paper.The relevant clinical data were systematically reviewed and studied,including 6 patients treated with traditional therapy(debridement,sufficient antibiotic treatment,fluid replacement,etc.),and 4cases of auxiliary application of VSD technology after surgical debridement,other treatment methods are the same.To analyze the clinical efficacy of VSD and traditional therapy in the treatment of scrotal gangrene in our hospital,systematically evaluate its pathogenic factors,etiology,clinical manifestations and treatment measures,and provide methods and experience for the clinical treatment of the disease.[Results]: Ten cases of gangrene of scrotum were reported in our hospital,including 6in the traditional treatment group,with an average age of 48.17 ± 12.07 years old,and 4in the VSD group,with an average age of 49.00 ± 15.08 years old.There was no statistical difference between the two groups(P > 0.05).Although two patients in the traditional treatment group were treated actively,their condition progressed rapidly,severe septic shock was difficult to correct,multiple organ failure resulted in death,and the mortality rate was 33.33%.The rest of the patients in the group were discharged after wound healing improved.In VSD group,4 patients were treated with VSD after debridement,the drainage of wound was more sufficient,the gangrene of scrotum and penis was more easily limited,and the wound healed smoothly before discharge without death.The cure rate was 80% and the death rate was 20%.The traditional treatment group(excluding the dead cases)needed frequent dressing change within two weeks after operation,with an average of 14.50 ± 2.08 times / week,while the VSD group did not need dressing change during the application of VSD device,only after the removal of VSD device began dressing change,with an average of 3.00 ± 0.82 times / week,the frequency of dressing change was significantly lower than the traditional treatment group(P < 0.001).The pain score of the traditional treatment group was 6.80 ± 0.84 in24 hours after operation(excluding one case who died less than 18 hours after admission),while that of the VSD group was 3.25 ± 0.50,significantly lower than that of the traditional treatment group(P < 0.001).The time of fresh wound granulation in the traditional treatment group(excluding the dead cases)was 18.75 ± 3.10 days on average,while that in the VSD group was 11.25 ± 2.99 days on average.The time of fresh wound granulation in the VSD group was significantly earlier than that in the traditional treatment group(P < 0.05).The average time of wound healing in the traditional treatment group(excluding the dead cases)was 79.50 ± 8.35 days,while that in the VSD group was 59.75 ± 11.97 days,significantly faster than that in the traditional treatment group(P < 0.05).[Conclusion]: Gangrene of scrotum is a kind of surgical emergency with rapid onset,rapid progress and serious threat to patients’ lives.It has a high mortality rate and needs early diagnosis and timely treatment.After scrotal gangrene debridement,VSD drainage device was used as an auxiliary treatment,which could significantly reduce the pain of patients,the number of dressing changes and the workload of clinicians.Moreover,it can accelerate granulation and promote wound healing.It is worthy of further clinical exploration and application.