We recommend daily antibiotic dressings such as 1% povidone iodine solution or 1% Silver sulfadiazine cream (Dermazin). Articoat and Selleck CYT387 hydrofiber dressing like Aquacel Ag is also a useful method for the control of the infection,

during the procedures of secondary wound defect closure [36, 47]. After the initial surgery, the wound must be carefully examined in general anesthesia every 24 h, to assess the tissue viability and necrotizing infection www.selleckchem.com/products/VX-680(MK-0457).html progress [36, 44]. Serial debridement must be performed more times (median range in our study was four times) because the necrotizing infection is rarely eradicated after a single debridement [36]. Perineal, perianal, or scrotal infections require special consideration (Figure 1). In the presence of a pressure sore, perineal abscess or paraplegia, necrotizing infection spreads into the scrotum, inguinal region and lower AW. In some particular cases, it is necessary to perform a diverting colostomy, cystostomy, or both to facilitate the formation of granulation tissues and wound hygiene, and to protect the flaps or skin grafts healing process. Selleck PD0332991 Surgical management includes wide tissue incision, radical debridement with orchiectomy and drainage of all involved areas [13]. The wound is abundantly washed with hydrogen peroxide, saline and 1% povidone

iodine solution. Finally, it is dressed with occlusive and adsorptive bandages with antiseptic, and changed twice daily. After the wound stabilizes and fresh granulations form,

we perform secondary soft tissue defect reconstructions. Figure 1 Postoperative view of Fournier’s gangrene and necrotizing fasciitis of the abdominal wall with closed divergent colostomy. NF of the AW and RS, even today, presents a challenging surgical issue. Skin incision must be performed in the longitudinal direction along the muscle-fascial layers of the inner AW until healthy fascia adherent to the overlying subcutaneous tissue and muscle is encountered. It is not indicated to perform Quisqualic acid two, three or more parallel incisions or any perpendicular incisions, because the bridges of skin and skin islands will usually not survive. Postoperative wound management on the AW consists of serial dressing changes during the next 24 h to 48 h, until the wound is free of recurrent or ongoing infection. When infection progresses across the deep fascial plane of the AW or a necrotic area on the skin appears, aggressive surgical debridement should be repeated. In our case with NF of the AW and RS we usually performed two to five debridement procedures to stabilize the wound conditions. The primary defect on the AW is usually large and it is repaired with advancement flaps using an abdominoplasty technique, biological mesh or skin grafts [48].