Vulvar necrotizing wounds: Unveiling mortality-associated parameters and assessing the efficacy of VAC therapy

Abstract

Introduction

Vulvar Necrotizing Fasciitis (VNF) is a critical, severe soft tissue infection characterized by aggressive progression and significant morbidity and mortality. Rapid diagnosis and immediate, comprehensive treatment, including antibiotic therapy, meticulous surgical debridement, and multidisciplinary care, are crucial for improving outcomes. This study aimed to investigate mortality-related factors in VNF and evaluate treatment modalities, focusing on Vacuum-Assisted Closure (VAC) therapy versus traditional debridement.

Methods

This retrospective study analyzed data from 22 VNF patients. Criteria included adults diagnosed with vulvar necrotizing infections, excluding those transferred or not completing treatment at the center. The study examined mortality-related factors and the efficacy of VAC therapy compared to debridement, considering treatment costs and outcomes.

Results

Analysis divided patients into survivors (13) and non-survivors (9). Higher heart rate, elevated WBC and CRP levels, and higher Clavien-Dindo scores were associated with increased mortality. VAC therapy, compared to traditional debridement, resulted in significantly lower CRP levels and reduced treatment costs. However, other parameters such as the length of hospital stay and debridement frequency showed no significant differences.

Conclusion

The study highlights that older age, systemic inflammation, and severe postoperative complications are key factors associated with higher mortality in VNF. VAC therapy emerges as a promising modality, effectively reducing systemic inflammation and healthcare costs. Nonetheless, the retrospective nature and the small sample size of the study limit the generalizability of the findings. Future research, particularly larger, multicentric studies, is essential to further explore and validate the effectiveness of VAC therapy in VNF management.