Negative Pressure Wound Therapy and Participation in Physical Therapy in a Patient with Fournier’s Gangrene: A Case Report

In this case report, the author describes the use of negative pressure wound therapy (NPWT) in addition to standard medical care to manage Fournier’s gangrene wounds in a 66-year-old male patient. Fournier’s gangrene is a necrotizing fasciitis of the external genitalia with necrosis of the superficial and deep fascia of the pelvis. The patient experienced necrosis of the skin and superficial tissues of the penis, scrotum, and inferior abdomen. Following surgical debridement, the patient received conventional gauze dressings.

The patient experienced pain with mobility, poor wound bed tissue quality, and poor exudate management. Additionally, a primary barrier to the patient’s participation in physical therapy was dressings coming loose upon standing. This was documented as a reason for stopping physical therapy during two consecutive sessions in the medical record. A new dressing was introduced: a NPWT dressing that utilized separate wound contact layers for the individual genital organs.

After this change, the patient’s clinical course improved in several ways. The patient’s wound developed a higher proportion of healthy granulation tissue with appropriate drainage management for moist wound healing. He experienced less pain with movement and there were no further incidents of dressings coming loose during mobility. The patient participated in physical therapy and his ambulation tolerance improved from two bouts of 45 feet with assistance to 250 feet continuously with supervision and a walker with the NPWT dressing in place. He ultimately underwent primary wound closure via split-thickness skin graft and rotational flap.

This surgery resulted in wound closure and a favorable cosmetic outcome. The case demonstrates potential benefits of NPWT for patients with Fournier’s gangrene, including wound bed preparation for primary closure and decreased barriers to participation in physical therapy.