Can the use of collagenase and hyaluronic acid gel reduce the number of repeated surgical debridements in Fournier's gangrene?

Objective: To compare the clinical outcome criteria between treatments of repetitive mechanical debridement, conventional dressings, and the use of collagenase and hyaluronic acid gel for patients with Fournier's gangrene (FG). Method: A retrospective analysis was made of the records of 56 patients with FG who were classified into two groups. In both groups, appropriate surgical debridement treatment was applied under operating room conditions at the time of diagnosis and as required. Group 1 comprised patients subsequently treated with daily repetitive mechanical debridement and conventional dressings. The patients in Group 2 were treated with mechanical debridement once per three days with the use of collagenase and hyaluronic acid cream after the initial surgical debridement. The two groups were compared in respect of the need for repeated surgical debridement, number of dressing changes, colostomy requirement, need to change the antibiotics and length of stay in hospital. Results: The mean age of the patients was 54.72±15.15 years and 26 patients had diabetes. The need for repetitive mechanical debridement and the number of dressing changes were significantly lower in the collagenase–hyaluronic acid group (p<0.05). There was no significant difference between the groups in respect of the need to change antibiotics, the need for colostomy and the length of hospital stay (all p>0.05). Conclusion: Collagenase-hyaluronic acid gel can be considered safe and useful in the management of FG to reduce the number of repeated mechanical debridements and dressing changes. This is the first study in the literature to have evaluated the use of this combination in the management of FG.