Comparison between vacuum sealing drainage (VSD) and conventional dressing for fournier's gangrene: a single-centre retrospective study.

BACKGROUND

Fournier's gangrene (FG) is a life-threatening infection associated with high mortality and often necessitates urgent surgical intervention. Vacuum sealing drainage (VSD) has emerged as a promising adjunct to surgical debridement; however, its impact on antibiotic stewardship remains inadequately studied. This study compares the efficacy of VSD and conventional dressings in the management of FG.

METHODS

In this single-center retrospective study, 104 patients with Fournier's gangrene (FG) treated between January 2022 and December 2023 were analyzed. Patients were categorized into VSD (n = 42) and conventional dressing (n = 62) groups following surgical debridement. Data included demographics, comorbidities, infection sites, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores, antibiotic duration, and clinical outcomes. Inverse probability of treatment weighting (IPTW) was applied to mitigate confounding biases.

RESULTS

Before IPTW adjustment, the VSD group exhibited longer durations in key clinical outcomes compared to the control group, including time to leukocyte normalization (+ 1.6 days), antibiotic use (+ 2.0 days), and hospital stay (+ 2.0 days). After IPTW adjustment, all three indicators showed improvement in favor of the VSD group. Generalized weighted regression further confirmed that VSD was associated with significant clinical benefits: shortened time to leukocyte normalization (mean difference: -1.8 days; 90% CI: -3.5 to -0.1), reduced duration of antibiotic therapy (-2.0 days; 90% CI: -3.7 to -0.4), and decreased length of hospitalization (-3.0 days; 90% CI:-5.7 to -0.4).Post-IPTW, VSD emerged as a protective factor, with all standardized mean differences (SMDs) remaining below 0.2, indicating acceptable covariate balance.

CONCLUSIONS

VSD may improve clinical outcomes in patients with Fournier's gangrene by accelerating recovery and reducing antibiotic use and length of hospitalization. These benefits appear more pronounced in patients with high LRINEC scores or extensive infections. Nevertheless, individualized treatment strategies should consider systemic disease severity, such as the Fournier's Gangrene Severity Index (FGSI).