Dakin's solution in the Management of Fournier's gangrene. By the way of a clinical case

Gustavo Leon .*; .** Pedro Fernandez, Nilda Hernandez .*; Silva Maria .***;

(*) Resident General Surgery Postgraduate Institute University Hospital in Los Andes (IAHULA) (**) Resident of General Surgery Hospital II (***) The Watcher Resident Graduate Institute of Obstetrics and Gynecology University Hospital Los Andes (IAHULA)

SUMMARY

Objective: To present clinical case which demonstrates the effectiveness of Dakin's solution for the treatment of infected wounds of varying etiology. Methods: Clinical case presentation and literature review. Setting: Service General Surgery Hospital Universitario de Los Andes. Mérida-Venezuela. Results: We obtained 150 cc of purulent fluid foul with debris and focal areas of necrosis extending to perineum scrotum compromising parietal layers of the same respecting the tunica albuginea.

Conclusion: The treatment of Fournier's gangrene is costly and merits a very long hospital stay. Two important aspects should be evaluated when choosing a suitable antiseptic, the risk of allergies and delayed healing. Petro Sian, et al. 1990 concluded that the use of hypochlorite solution favors tissue susceptibility by antibiotics and promote debridement of tissues, is property that was evident in the treatment of this patient

Keywords: gangrene, Fournier, Dakin

SUMMARY

Objective: To present a clinical case Demonstrate the Effectiveness of Dakin's solution for the Treatment of Infected Wounds of diverse origin. Method: A case report and literature review Environment: Service of General Surgery of the University Hospital of Los Andes. Mérida - Venezuela. Results: 150cc liquid of fetid purulent Were Obtained, With debris and focal areas of necrosis in the perineum scrotum Extending Into Compromising STI parietal layers, With no harm done to the albugineam tunica. Conclusion: Treatment of Fournier's gangrene is Costly and Merits a very long hospital stay. Two important Evaluated Aspects Must Be A Suitable When choosing antiseptic, The Risk of allergies and delay healing. Petrosian et al. 1990 Concluded That the use of hypochlorite solution favors Antibiotics susceptibility of tissue by debridement and please of tissues. This property WAS Proven in the trearment Given to this patient

Key words: Gangrene, Fournier, Dakin

INTRODUCTION

Fourier's Gangrene is defined as an explosive and aggressive infection of the perineal, perianal and genital. Described initially in 1764 and later Baurienne by Alfred Fournier in 1883 as a gangrenous process of unknown cause, which is currently considered poly microbial infections in which both aerobic and anaerobic bacteria act synergistically causing great destruction of tissue. The most frequently isolated bacteria are Escherichia coli and Bacteroides between aerobic anaerobic between, there is an average of four isolates per case mortality in international series goes from 3 to 67%, occur in older patients and carriers of chronic diseases, their management is predominantly multidisciplinary and should be early and aggressive in order to effectively modulate the progression infectious. The severity and high mortality of the box depends on several factors: the focus of anorectal beginning, advanced patient age and the presence of underlying conditions such as chronic alcohol abuse, poorly controlled diabetes and the use of immunosuppressive drugs such as corticosteroids and antineoplastics.

Patients with alcoholism, diabetes, malnutrition, and malignancies are more likely to develop the clinical picture. The gateway is usually a mild injury to the genital level. It is also common that the picture is developed from abscesses or anal fissures, colon holes (for tumors or traumatic) or hidradenitis. The existence of an anal or rectal bulb has a worse prognosis.

Dakin's solution

Dakin's solution is a mixture of a chemical consisting of elemental chlorine in the form of undissociated hypochlorous acid (HOCL) at 0.5% to 0.18% title also contains baking soda to 3% and pH 8.7. Today is the topical antimicrobial agent for cleaning wounds more effective. It transcends topical antimicrobial effects and toxicity to tissues such as povidone iodine products, acetic acid and hydrogen peroxide. Povidone iodine solution bactericidal at concentrations of 1% and 0.05% concentration is toxic to fibroblasts, the 0.25% Acetic Acid is toxic to fibroblasts and not bactericidal. Hydrogen peroxide (hydrogen peroxide) 3% at concentrations of 0.3% is also toxic to fibroblasts and bactericidal only 3%. Sodium hypochlorite at concentrations of 0.025% is bactericidal and harmless fibroblasts, this product is effective bactericidal after 24 hours of application, making it an excellent agent for cleaning wounds in outpatients when human resources are limited or it is necessary to reduce costs.

Leave the wound with dressings soaked in sodium hypochlorite solution is the best proven technique to reduce the number of bacteria in wounds. Sodium hypochlorite has broad spectrum antiseptic and bactericidal for Pseudomonas aeruginosa, S. aureus and other Gram-positive and Gram negative organisms. The sodium hypochlorite solution also promotes wound healing, increasing the strength in epithelial junctions.

CL CASE? NICO

This male patient, X years old, from Merida Natura and current disease characterized by pain and swelling in the perineal region, where CDI comes to values, practices and indicate drainage Pronap ® syringe Intramuscular. Motivated to be associated with increased pain and increased volume, which covers up redness associated scrotum intense stench decide to try and open drainage IAHULA reference our service, where value is decided upon admission.



FIGURE 1: scrotal lesions, perineal and perianal patient upon admission.

REVIEW F? SICO: 135/90 mmHg TA = FC: 102 bpm FR: 18 rpm

Luce in apparent poor general health, active supine obliged facies peak, marked mucosal cutaneous pallor, chest normo symmetric expandable MV in both lungs without additions, Cardiac Rhythm sounds without murmurs. Abdomen soft nontender. Perineum bulging, erythematous in its surroundings, leaving very offensive purulent discharge and a large amount of devitalized tissue including sphincter compromise.

PARACL? NICA: We performed reported Hematology complete with XX/mm3 LEU = XX% segmented neutrophils. HB: XXgr%. We also perform reporting secretions culture:

Escherichia coli beta-hemolytic Streptococcus, Klebsiella sp.



FIGURE 2:? Areas of focal necrosis scrotum



FIGURE 3: purulent perineal injury and necrosis

EVOLUTION:

He decides to operating room where general anesthesia is performed inhalation of perineal wound debridement evidencing 150cc liquid out very offensive purulent debris and focal areas of necrosis in the perineum, is then taken to hospital ward where he stayed for 10 days launderers with Dakin's solution twice a day, the seventh day is taken again sample for culture, which reported negative for bacterial growth. Subjectively the patient reported progressive decrease in pain until his death. To show negative culture and the formation of healthy granulation tissue was performed outpatient wound closure with absorbable suture and discharged on the tenth day of hospitalization.



FIGURE 4: scrotum and perineum fully recovered, with only 10 days of hospitalization

Bibliography? A

1. Allan D. SOLUTIONS in wound DAKINS Treatment. Arch Surg. 1988. 123:1525-6. 2. Petrosian EA Sergienko VI, Kulaef GK, Martinof AK, or lechenil natriia Gipokhlorit gnoinyknran. (Sodium hypochlorite in the Treatment of supurative wound). Vestn Khir Im II Grek 1991; 146:40-3. 3. GL Smith, CB Bunker, MD Dinneen, Fournier's gangrene, review. Br J Urol 1998, 81: 347-55. 4. Laucks SS: Fournier's gangrene. Surg Clin North Am 1994; 74: 1339-52. 5. Valenzuela R, Radich P, Hernandez J, Toro P, Fournier gangrene penis scrotum. Rev Chil Cir 1991, 43: 377-9. 6. Amendola MA, Box J, Joseph R et al: Fournier's gangrene: CT Findings. Abdomen Imaging 1994, 19: 471-4.

Source: Medical Portals.

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