To investigate the effect of vacuum sealing drainage(VSD) combined with convection irrigation to repair Fournier gangrene wound by the comparing of groups.

Sixteen Fournier gangrene patients admitted in People′s Hospital of Xinjiang Uygur Autonomous Region from January 2012 to September 2016 were selected. Four cases refused to use VSD were divided into the traditional dressing group, the other 12 cases were randomly divided into VSD group(6 cases) and VSD combined with convection irrigation group(6 cases). All patients accepted stage Ⅰ debridement after anti-infection and control of blood sugar therapy. VSD group: according to the size and shape of the wound, negative pressure material was cut into a suitable shape, then fully contact and fill the residual cavity of the wound with it and ensure no dead cavity remained. After the wound was closed, the negative pressure was attract the hospital center′s, it was 15 mmHg (1 mmHg=0.133 kPa). VSD combined with convection irrigation group: on the basis of the VSD group, 0.9% sodium chloride solution was used to flush the wound through the infusion set. Traditional dressing group: Debrided the wound carefully, then used 0.9% sodium chloride solution and 3% hydrogen peroxide solution rinsed the wound repeatedly, try to keep the wound clean and used ethacridine lactate to fill the wound and then covered it with dressing. The bacterial clearance rate, stage Ⅱ suture technique, average wound closure time, total hospitalization time, patient satisfaction, the number of VSD used and the blocking rate of VSD were analyzed statistically, and the efficacy of the treatment of the three groups were evaluated. One-way analysis of variance, LSD method and χ² test were performed on the data.

After the treatment, the granulation tissue in VSD group growth better, the wound of VSD combined with convection irrigation group was basically covered by the red granulation tissue and the granulation tissue dispersed in the traditional dressing group, and there are still necrosis tissue and secretion attached to the base, the skin inflammatory reaction was heavy. There was a statistically significant difference in the removal rate of wound bacteria in 3 groups (F=41.707, P<0.05). The bacterial clearance rate was (58.7 ± 4.5)% in the traditional dressing group, which was significantly lower than that in the VSD group (79.8 ± 5.6)% and VSD combined with convection irrigation group (93.6 ± 6.9)% (t=5.522, 9.133, with P values below 0.05). The wound clearance rate of VSD group was significantly lower than that of VSD combined convection irrigation group (t= 4.038, P= 0.001). Five cases of stage Ⅱ in VSD group were treated with suture and graft to closed wound, 1 case′s skin flap of the inguinal region was inflamed obviously. After suture, the incision was maintained with more secretion exudation and the wound was gradually healed after strengthen debridement and dressing. The stage Ⅱ suture in VSD combined with convection irrigation group was treated by direct suture, which was basically closed wound and the wound healed well. One case of traditional dressing group was treated with direct stage Ⅱ suture combined with local skin grafting and partial skin graft survival, the remaining three cases accepted local flap transfer repair and free skin grafting to closed the wound. The average wound closure time of the 3 groups was statistically significant (F=25.989, P<0.05). The average wound closure time of traditional dressing group was significantly higher than that in VSD group and VSD combined with convection irrigation group, and the difference was statistically significant (t=4.931, 7.195, with P values below 0.05), and the average wound closure time of VSD group was significantly larger than that of VSD combined with convective irrigation group, the difference was statistically significant (t=2.655, P=0.018). The total hospitalization time of 3 groups was statistically significant (F=25.707, P<0.05), and the total hospitalization time of traditional dressing group was (38.3±9.3) days, which was significantly larger than that of VSD group [(22.3±3.4) days]. VSD combined with convection irrigation group was [(16.7±2.0) days], the difference was statistically significant (t=5.263, 7.106, with P values below 0.05), and the total hospitalization time of VSD group was significantly larger than that in VSD combined with convection irrigation group (t=2.160, P=0.047). The tube plugging rate was 44.4% (12/27) in VSD group and 15.8% (3/19) in VSD combined convective irrigation group. There was statistically significant difference between the two groups (χ² = 4.167, P=0.041). Although patients in VSD group had no obvious pain during the treatment, the cost was higher. The wound healing of VSD combined with convective irrigation group was well, and the patient satisfaction was the highest. In the traditional dressing group, the pain was severe, the hospitalization time was long, and the wound closure effect was not satisfactory.

VSD combined with convection irrigation can quickly dilute the secretion of the wound, reduce the wound infection, effectively solve the blockage, ensure the drainage and provide a good growth environment for the wound healing, which is worth popularizing in clinical practice.