Efficacy of Wound Coverage Techniques in Extremity Necrotizing Soft Tissue Infections

Abstract

Little data exist about management of wounds created by debridement in necrotizing soft tissue infections (NSTIs). Multiple wound coverage techniques exist, including complete primary wound closure, split-thickness skin grafting, secondary intention, and flap creation. We hypothesized that all wound coverage techniques would be associated with high rates of successful wound coverage and low crossover rates to other wound coverage techniques. NSTIs over a three-year period were retrospectively reviewed. Both the initial and secondary wound coverage techniques (if necessary) were recorded. The primary outcome was the ability to achieve complete wound coverage. Overall, 46 patients with NSTIs had long-term data available. Of the patients undergoing split-thickness skin grafting as the initial wound coverage technique, 8/8 (100%) achieved complete wound coverage; and of those undergoing flap creation, 1/1 (100%) achieved complete wound coverage; and of those undergoing complete primary wound closure, 4/4 (100%) achieved complete wound coverage. Of the patients undergoing secondary intention as the initial wound coverage technique, 5/33 (15.2%) achieved complete wound coverage and 28/33 (84.8%) required a secondary wound coverage technique with split-thickness skin grafting. All 46 patients achieved long-term successful wound coverage. Time to wound coverage did not vary with initial wound coverage technique ( P = 0.44). Split-thickness skin grafting, flap creation, complete primary wound closure, and secondary intention are all reasonable choices for initial wound coverage for NSTIs. Although secondary intention had a low success rate as an initial wound coverage technique, all patients ultimately achieved complete wound coverage without a significant increase in time to coverage.

In vivo efficacy proof of concept of a large-size bioprinted dermo-epidermal substitute for permanent wound coverage

“…The cutoff ratio deeming the success or failure of skin graft take is not consensual. It depends on intrinsic and extrinsic factors (such as the location, thickness, or type/etiology of the defect) and varies from 50% to 90% in the literature ( Birchall et al, 1991 ; Kirsner et al, 1995 ; Thourani et al, 2003 ; Shores et al, 2012 ; Reddy et al, 2014 ; Lauerman et al, 2018 ; Braza and Fahrenkopf, 2022 ). In clinical applications of skin grafts, we consider an engraftment of over 80% of the graft area on days 15–21 as successful since the patient does not require additional procedures.…”

Autologous Cell Harvesting System as Adjunct for Soft-tissue Reconstruction of Necrotizing Soft Tissue Infection

“…A study in 46 NSTI patients concluded that reconstruction with STSG was best. 13 While STSG may be the most viable option, drawbacks include an additional wound, pain management, and significant scarring limiting functionality as well as poor cosmetic outcomes.…”

Comparative Study between Split Thickness Skin Graft and Split Thickness Dermal Graft in Coverage of Raw Areas

“…The procedure results in a second painful wound that may take more time for healing than the graft site itself [4]. Such wound also carries the risk of some complications like infection, hyper or hypo pigmentation, burning sensation, itching and even excessive scarring that may minimize the range of motion [2]. The split-thickness skin graft is a weak coverage that may ulcerate if exposed to mechanical forces, also it may adhere to the underlying structures [5,6] in addition to limited donor site availability in major burns [7].…”