What are investigational treatments for Fournier gangrene?

Updated: Jun 03, 2021
  • Author: Vernon M Pais, Jr, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The role of topical agents in wound care requires further investigation. Unprocessed honey, applied directly to the surface of the wounds, has been reported by some authors to enzymatically debride, sterilize, and dehydrate wounds and to improve local tissue oxygenation and re-epithelialization. However, the salutatory effect of honey is likely related to its physical property of hyperosmolarity. [76] Therefore, honey holds little advantage over other hygroscopic agents. [77]

The application of growth hormones and other trophic agents holds the potential to promote faster wound healing.

One published case report advocates irrigation of the perineum with superoxidized water as well as application of gauze soaked in zinc peroxide and hydrogen peroxide.

In patients who require cutaneous reconstruction for tissue loss secondary to necrotizing soft tissue infections, including Fournier gangrene, Hersant et al reported significantly improved clinical outcomes and shortened wound healing time when split-thickness skin grafting (STSG) is followed by spraying autologous platelet-rich plasma (A-PRP) and thrombin gel on the wound bed and on the graft after stable fixation. In their prospective, controlled, open-label randomized study, the mean complete healing time was almost 50% shorter in patients (n=14) who received STSG plus A-PRP/thrombin gel than in those (n=13) receiving STSG alone (37.9 vs. 73.7 days, respectively; P=0.01). [78]

Use of intravenous immunoglobulins (IVIG) and therapeutic plasma exchange (TPE) have been reported, although evidence is limited. [65]


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