Achieving A Consistent Approach to Apply NPWT To Genital/ Perineal Wounds

Necrotizing Faciitis is a life threatening infection requiring urgent surgical intervention. The tissue destruction caused by this infection and the need for surgical debridement can result in extensive wounds. This is especially the case when dealing with Fournier's Gangrene. This is a form of Necrotizing Fasciitis that occurs in the genital/perineal area.It is well documented in the literature that NPWT is a benefical treatment to aid in wound healing in these situations. However due to the location of these wounds, maintaining a seal with the NPWT can be challenging. My partner and I came up with a technique to help maintain the seal. To begin once the wound is visualized and the approach of foam placement decided, the foam pieces are cut out. If the testicles are exposed these are wrapped with vaseline gauze. Next the skin on either side of the groin and perineal area is dried. Sometimes this requires the use of a hairdryer on a low cool setting to accomplish it. Then the skin is painted with a benzoin product. Ostomy barrier rings are employed on either side of the perineum, scrotum and sometimes the penis. Then the foam is placed and the NPWT is initiated at the ordered pressure. Because the dressing changes can be time consuming, the dressings are changed Monday, Wednesday, Friday. This technique has been used on the 9 patients with extensive genital/perineal wounds over the past 3 years at our facility with positive results each time. The technique can be easily taught to the nursing staff and surgeons. My partner and I have adopted this approach whenever we are faced with these challenging wounds.