Application of a controlled fecal diversion system for the prevention of wound contamination in necrotizing fasciitis of the perineum and perianal region

Annotation. The aim of this study is to evaluate the effectiveness of a controlled fecal diversion system in reducing the risk of wound contamination in patients with necrotizing fasciitis of the perineum, perianal area, and genitalia, and to analyze the feasibility of its use for simplifying postoperative care and facilitating wound closure with skin grafting. We analyzed treatment outcomes of 150 patients with necrotizing fasciitis treated between 1999 and 2024 at the surgical clinics of Danylo Halytsky Lviv National Medical University. Among them, in 21 (14%) patients, the pathological process was localized within the perianal area and perineum. To assess wound care effectiveness, a comparative analysis was performed among patients undergoing traditional colostomy, attempts at skin grafting without fecal contamination control, and the use of controlled fecal diversion systems. Complications in wound care and skin graft closure in the perineal and perianal areas were frequently associated with fecal contamination, leading to unsuccessful grafting attempts and prolonged healing by secondary intention. Temporary colostomy allowed successful skin grafting but extended treatment by an average of 6 weeks and caused additional inconvenience to patients. In two patients (9.5%), the controlled fecal diversion system was used successfully, ensuring reliable isolation from contamination, successful skin grafting, and rapid healing (within 11 days). Using a controlled fecal diversion system in treating necrotizing fasciitis of the perineal and perianal regions is an effective method for preventing fecal wound contamination. This allows you to successfully perform plastic wound closure, simplify postoperative care and avoid creating a temporary colostomy.