Above knee amputation due to necrotizing fasciitis caused by gas producing strain of Echerichia coli and negative pressure therapy assisted closure of large open wound

Abstract

Introduction. Nonclostridial gas-forming soft tissue infections (NGSTI) are rare, rapid progressive infections that are caracterized by high mortality and high proportion of amputations. Surgical debridement is crucial in therapy and it results in complex wounds that need to be closed to prevent secondary morbidity. Case report. Herein we present a case of NGSTI in a 68-year-old patient with diabetes mellitus with acute thrombosis of popliteal artery aneurysm and radiological signs of gas in his right leg and in urine bladder wall. Infection was caused by gas-forming strain of Escherichia coli. The patient was early treated with femoral amputation and antibiotics. A vacuum asistet closure (VAC) treatment has been applied. Administered VAC therapy resulted in primary wound closure without complications 17 days after surgery. Conclusion. Negative pressure increase wound fluid removal and infection clerance while, also, increases wound contraction and aproximation of skin flaps. VAC therapy can be good adjunctive treatment for closure of large open wounds for the patients with NGSTI to avoid extensive reconstructive surgery.