Extended negative pressure wound therapy-assisted dermatotraction for the closure of large open fasciotomy wounds in necrotizing fasciitis patients

Abstract

BackgroundNecrotizing fasciitis (NF) is a rapid progressive infection of the subcutaneous tissue or fascia and may result in large open wounds. The surgical options to cover these wounds are often limited by the patient condition and result in suboptimal functional and cosmetic wound coverage. Dermatotraction can restore the function and appearance of the fasciotomy wound and is less invasive in patients with comorbidities. However, dermatotraction for scarred, stiff NF fasciotomy wounds is often ineffective, resulting in skin necrosis. The authors use extended negative pressure wound therapy (NPWT) as an assist in dermatotraction to close open NF fasciotomy wounds. The authors present the clinical results, followed by a discussion of the clinical basis of extended NPWT-assisted dermatotraction.MethodsA retrospective case series of eight patients with NF who underwent open fasciotomy was approved for the study. After serial wound preparation, dermatotraction was applied in a shoelace manner using elastic vessel loops. Next, the extended NPWT was applied over the wound. The sponge was three times wider than the wound width, and the transparent covering drape almost encircled the anatomical wound area. The negative pressure of the NPWT was set at a continuous 100 mmHg by suction barometer. The clinical outcome was assessed based on wound area reduction after treatment and by the achievement of direct wound closure.ResultsAfter the first set of extended NPWT-assisted dermatotraction procedures, the mean wound area was significantly decreased (658.12 cm2 to 29.37 cm2; p = 0.002), as five out of eight patients achieved direct wound closure. One patient with a chest wall defect underwent latissimus dorsi musculocutaneous flap coverage, with primary closure of the donor site. Two Fournier’s gangrene patients underwent multiple sets of treatment and finally achieved secondary wound closure with skin grafts. The patients were followed up for 18.3 months on average and showed satisfactory results without wound recurrence.ConclusionsExtended NPWT-assisted dermatotraction advances scarred, stiff fasciotomy wound margins synergistically in NF and allows direct closure of the wound without complications. This method can be another good treatment option for the NF patient with large open wounds whose general condition is unsuitable for extensive reconstructive surgery.

Fasciotomy closure using negative pressure wound therapy in lower leg compartment syndrome

“…Authors applied extended NPWT over dermotraction on mean initial open wound area of 658 cm 2 and they gained direct closure in 7 out of 8 patients in a mean time of 16 days (19). These data support our hypothesis that the combination of these two techniques is advantageous, but in our study we had different type and size of FW.…”

Evaluation and Management of Necrotizing Soft Tissue Infections

“…Newer vacuum assisted closure products are accompanied by continuous wound irrigation, which may be beneficial in wounds from debridement of NSTI 54 . Negative pressure dressings can provide dermotraction to limit the wound size and facilitate closure 55 . In the case of complex and repeated reconstructive surgeries, rehabilitation, physical therapy or occupational therapy may be necessary and treatment courses can be significantly life-altering and prolonged.…”

Negative Pressure Wound Therapy for Necrotizing Fasciitis and Compartment Syndrome of the Upper Extremity — a case report

“…Necrotizing fasciitis is a life-threatening severe infection characterized by extensive soft tissue necrosis along fascial planes involving the subcutaneous region and skin. [1][2][3][4][5]11 NF can appear on various body regions, but most often on the extremities. 3, 4, 11 It is often caused by monobacterial (Streptococcus pyogenes) infection but polymicrobial or fungal origins are not rare either.…”

“…In advanced cases, skin bullae and necrosis can develop. [2][3][4]11 In advanced cases, anxiety can develop as a sign of generalized septic-toxic signs. 8 When the disease is localized in the extremities, concomitant compartment syndrome is often observed.…”