Abstract
Objectives: Fournier’s gangrene is an aggressive frequently fatal polymicrobial soft tissue infection of perineum and external genitalia requiring immediate radical surgery. Postoperative management includes mesh-graft and skin-flaps. We used low intensity shock wave therapy (Li-ESWT) in the management of wound healing following Fournier`s gangrene in three case series.
Materials and Methods: Li-ESWT was applied three times weekly with 2000-3000 shock waves at 3-4 Hz (Energy flux density: 0.25 mJ/mm2) using Duolith SD1 ultra without anesthesia. In one year, we treated 8 patients at two centers in Europe and Asia. Based on planimetric assessment of the wound area at respective times, we calculated the re-epithelization speed (cm2/d).
Results: Case series 1: Three patients after secondary healing of a skin flap. In all cases wound-healing was promoted within 6-7 weeks (re-epithelization speed 0.24-0.42 cm2/d). Case series 2: Two patients were primarily treated successfully over 6-7 weeks with significant closure of the wound (re-epithelization speed 0.65-0.79 cm2/d) followed by mesh-graft. Case series 3: Three patients exclusively treated by Li-ESWT showed complete restoration of penile and scrotal tissue within 4-5 months (i.e. re-epithelization speed of 0.47-0.70 cm2/d).
Conclusions: Li-ESWT could become an interesting non-invasive treatment modality for patients with secondary wound problems (i.e. Fournier`s gangrene).