The role of negative-pressure wound therapy in Fournier's gangrene: Association with mortality.

BACKGROUND: Fournier's gangrene (FG) is a rare but life-threatening necrotizing fasciitis of the perineal and genital regions characterized by rapid progression, fulminant sepsis, and high mortality. Negative-pressure wound therapy (NPWT), also called vacuum-assisted closure (VAC), is becoming more commonly utilized today in the treatment of complex wounds. This study aimed to evaluate the association between NPWT/VAC and in-hospital mortality among patients with FG requiring extensive surgical debridement. METHODS: This retrospective cohort study included 95 patients treated for FG at a tertiary referral center between January 2022 and January 2025. Patients were divided into two groups according to post-operative wound management: Conventional dressing (n=31) and NPWT/VAC (n=64). Demographic, clinical, and laboratory data - including the FG severity index (FGSI), quick sequential organ failure assessment, and procalcitonin - were analyzed. Multivariable logistic regression identified independent predictors of in-hospital mortality, and model performance was evaluated using receiver-operating characteristic curves. RESULTS: Overall mortality was 20.0% (19/95). Mortality was significantly lower in the NPWT/VAC group than in the conventional group (15.6% vs. 29.0%, p<0.05). On multivariable analysis, NPWT/VAC was independently associated with lower mortality (adjusted odds ratio [OR] 0.42, 95% confidence interval [CI] 0.18-0.95, p<0.05), whereas higher FGSI (OR 1.28 per point, 95% CI 1.10-1.55, p<0.01) and procalcitonin (OR 1.95, 95% CI 1.35-2.75, p<0.01) were independently associated with higher mortality. CONCLUSION: NPWT/VAC use was associated with a lower mortality rate and may represent a valuable adjunct in the management of severe FG.