VAC (Vacuum Assisted Closure) treatment in Fournier's gangrene: personal experience and literature review.

INTRODUCTION: Fournier's gangrene (FG) is a rapidly developing necrotizing fasciitis that originates in genital and perineal region. The mortality rate is high and requires prompt diagnosis, antibiotic treatment and extensive necrosectomy with derivative colostomy. Vacuum Assisted Closure (VAC) is a wound care system of paramount importance in the treatment of complex wounds, including the perineum. MATERIALS AND METHODS: We evaluated 6 cases of FG (males, mean age: 54.6 yrs) of the last 3 years (February 2008-August 2010). All patients were diabetics. We used intravenous antibiotic treatment and early surgical debridement with colostomy, followed by immediate positioning of a VAC device (NP 125-200 mmHg). The dressing changes were done every 3-4 days. Hyperbaric oxygen therapy (HBOT) was given only to one patient. Microbiological etiology was assessed by multiple cultures to tailor the antimicrobial treatment. RESULTS: The VAC therapy reduces the number of dressings and the hospital length of stay (LOS), in agreement with the literature; in one of the cases a secondary reconstructive surgical intervention was possible. The colostomy was reversed in all patients within 3 months. CONCLUSIONS: Negative pressure is a time saving device, reducing days of hospitalization, patient's discomfort and number of medications. The possibility of a early reconstructive surgery improves significantly quality of life.

Mutagenicity (micronucleus test in Vicia faba root tips), polycyclic aromatic hydrocarbons and heavy metal content of sediments collected in Tiber river and its tributaries within the urban area of Rome.

Sediments collected in Tiber river and in its main tributary water courses within the urban area of Rome were tested for mutagenicity by means of Vicia faba root tips micronucleus (MN) test. Representative samples were scored for micronucleus generating events (chromosome/chromatid loss and fragments) too. Sediments were assayed for content of the thirteen most important chemicals of polycyclic aromatic hydrocarbon (PAH) group and for some heavy metal ions (Cd, Cr, Cu, Ni, Pb, Zn). Samples were collected in four tributary rivers (Prima Porta, Acqua Traversa, Aniene and Magliana) just before their confluence with Tiber river and at different stations along the Tiber river itself upstream and downstream the sites of confluence of the sampled tributaries. All samples were collected in July 1992. An alarming level of mutagenicity was reached in most of the tested stations, with an effect comparable to an X-rays exposure up to 0.4 Gy. Chemical analysis showed that the total amount of identified PAHs ranged from 4.5 to 625.2 ng/g of dry matrix in the different stations and the total amount of heavy metals ranged from 130 to 570 ppm. Tiber mutagenicity is likely to be mainly due to local factors such as the confluence of a small polluted tributary rather than to large scale effect due to an upstream-downstream relationship.