Abstract
Aims: Necrotizing fasciitis (NF) is a life threatening infection of the subcutaneous tissues that spreads along the underlying fascia. Despite the early and aggressive surgical fasciotomy and necrosectomy its mortality rate is still high. In NF the negative pressure wound therapy (NPWT) has good effects on wound healing and on the primary closure of the concomitant extended tissue defects.
 Case report: A 32 year-old male patient was admitted with four-day history of fever (39.1 C⸰), pain, swelling, erythema of the right elbow and upper arm. On admission extensive erythema and swelling were seen on the right forearm, arm and the pectoral region with superficial skin bullas on it. On the basis of the clinical signs, laboratory tests, immediate surgery was indicated. Extended fasciotomy and necrosectomy were performed on the full extremity and pectoral region. Negative pressure wound therapy was started immediately with -120 mmHg of pressure. Antibiotic therapy was also administered.
 Results: After five cycles of NPWT the patient recovered without the need of any plastic surgical intervention. The functional and aesthetic results were excellent.
 Conclusion: In case of extended NF of the upper extremity the aggressive surgery and NPWT are safe and effective.
Highlights
N ECROTIZING fasciitis (NF) is a relatively rare, but lifethreatening disease
After five cycles of negative pressure wound therapy (NPWT) the patient recovered without needing any plastic surgical intervention
Negative pressure wound therapy is a frequently used method in the treatment of necrotizing fasciitis based on its advances in complex wound care
Summary
N ECROTIZING fasciitis (NF) is a relatively rare, but lifethreatening disease. The extremities are most commonly affected, followed by the trunk.[1,2,3,4,5] It has monobacterial (β-hemolytic Streptococcus), polymicrobial or fungal etiology.[1, 4, 6,7,8] Local symptoms are pain, erythema, tenderness, swelling, induration, and crepitation.[2, 3, 6] In advanced cases, skin bullae and necrosis can develop. Conclusion: In the case of extended NF of the upper extremity the aggressive surgery and NPWT are relatively safe and effective. The effective treatment based on the early diagnosis is the aggressive surgical debridement and fasciotomy, broadspectrum antibiotic therapy and supportive intensive care.
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