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

Jun Yong Lee,Ho Kwon,Sung-No Jung,Hyunwook Jung

doi:10.1186/1749-7922-9-29

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.

Highlights

Necrotizing fasciitis is a rapid progressive infection of the subcutaneous tissue or fascia that usually occurs in the groin and lower extremities [1]
The authors present a report of clinical results of this practice, followed by a discussion of the clinical basis of extended negative pressure wound therapy (NPWT)-assisted dermatotraction in closing the large open wound of the necrotizing fasciitis patient
All patients underwent periods of wound preparation by necrectomies and fasciectomies for infection clearance, and were treated with extended NPWT-assisted dermatotraction for the closure of the resultant open wounds caused by necrotizing fasciitis

Summary

Introduction

Necrotizing fasciitis is a rapid progressive infection of the subcutaneous tissue or fascia that usually occurs in the groin and lower extremities [1]. Dermatotraction in the necrotizing fasciitis patient may be ineffective, and the traction can disturb circulation in the stiff skin flaps, resulting in skin necrosis It provides an attractive alternative for the necrotizing fasciitis patient in poor general condition, dermatotraction has remained an alternative surgical option to date. To decrease the likelihood of skin flap necrosis, and to facilitate skin flap mobilization for direct wound closure in the necrotizing fasciitis patient who had undergone dermatotraction, the authors applied extended NPWT over the dermatotraction device during treatment of the open wound. The authors present a report of clinical results of this practice, followed by a discussion of the clinical basis of extended NPWT-assisted dermatotraction in closing the large open wound of the necrotizing fasciitis patient. 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

Methods

Results

Conclusion