Outcomes of vacuum-assisted closure therapy (VAC) in patients with Fournier's gangrene: a retrospective cohort study.

OBJECTIVE

To evaluate the association between vacuum-assisted closure therapy and clinical outcomes, particularly mortality, in patients surgically treated for Fournier’s gangrene.

METHODS

This retrospective cohort study included 268 patients treated for Fournier’s gangrene between 2015 and 2025. Patients were divided into two groups: debridement alone (Group 1, n = 160) and debridement plus vacuum-assisted closure therapy (Group 2, n = 108). Demographic characteristics, comorbidities, laboratory findings, Fournier Gangrene Severity Index, intensive care unit admission, additional surgical procedures, length of stay, and mortality were compared. Multivariate logistic regression was performed to identify independent predictors of mortality.

RESULTS

Observed mortality was lower in the vacuum-assisted closure therapy group than in the debridement-only group (7.4% vs. 16.9%, p = 0.038). However, multivariate analysis demonstrated that only intensive care unit admission (OR 6.40, 95% CI 1.52–26.89, p = 0.011) and Fournier Gangrene Severity Index score (OR 5.57, 95% CI 2.91–10.71, p < 0.001) were independently associated with mortality. Vacuum-assisted closure therapy was not an independent predictor (OR 0.58, 95% CI 0.16–2.10, p = 0.409). The vacuum-assisted closure therapy group underwent more debridement procedures and had a longer hospital stay.

CONCLUSION

Although vacuum-assisted closure therapy was associated with lower unadjusted mortality, survival was primarily determined by disease severity and intensive care unit admission. Vacuum-assisted closure therapy may improve wound management; however, its impact on survival appears influenced by baseline clinical status. Prospective studies are needed to clarify its role in Fournier’s gangrene management.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s11845-026-04416-w.