From the Guidelines
Perianal wounds should be treated with aggressive surgical debridement, prompt antibiotic therapy, and measures to promote healing while preventing infection, as this approach has been shown to improve survival and reduce morbidity in patients with Fournier’s gangrene 1.
Treatment Approach
The treatment of perianal wounds, particularly in the context of Fournier’s gangrene, involves a multidisciplinary approach that includes:
- Early and extensive surgical debridement to remove all necrotic tissue 1
- Prompt antibiotic therapy to manage infection
- Measures to promote healing, such as wound care and pain management
- Consideration of fecal diversion, such as colostomy, in cases with fecal contamination 1
Wound Care
Wound care for perianal wounds involves:
- Gentle cleansing with warm water and mild soap
- Application of a barrier cream to protect the skin
- Use of sitz baths to reduce pain and promote healing
- Maintenance of soft stools using fiber supplements and adequate hydration to prevent straining during bowel movements
Pain Management
Pain management for perianal wounds involves:
- Use of over-the-counter medications, such as acetaminophen or ibuprofen
- Consideration of topical antibiotics, such as mupirocin ointment, for infected wounds
Surgical Management
Surgical management of perianal wounds, particularly in the context of Fournier’s gangrene, involves:
- Radical surgical debridement to remove all visible necrotic tissue 1
- Consideration of orchiectomy or other genital surgery, if necessary
- Planning for early and delayed surgical sequelae with a multidisciplinary team
Fecal Diversion
Fecal diversion, such as colostomy, may be considered in cases with fecal contamination to promote wound healing and reduce morbidity 1.
Negative Pressure Wound Therapy
Negative pressure wound therapy (NPWT) may be used to promote wound healing, particularly in cases with complex wounds or those that are difficult to manage with traditional dressings 1.
From the Research
Treatment of Perianal Wounds
The treatment of perianal wounds involves various methods, including:
- Regular cleaning of the wound with conventional disinfection solution 2
- Use of topical treatments such as 1% silver sulphadiazine 3
- Administration of broad-spectrum antibiotics and tetanus prophylaxis 3
- Parting the natal cleft regularly to avoid adhesion and anal stenosis 3
- Use of vacuum sealing drainage (VSD) technique to achieve secure and rapid wound healing 2
- Skin grafting after the infection is controlled 2
Prevention of Perianal Infection
To prevent perianal infection, the following methods can be used:
- Povidone iodine-diluted sitz bath 4
- Perianal cleaning care 4
- Use of antibiotics such as ciprofloxacin and metronidazole 5
- Surgical drainage of perianal abscess 5
Management of Postpartum Perineal Wound Complications
The management of postpartum perineal wound complications involves: