Negative Pressure Wound Therapy With Instillation as an Early Intervention for Extensive Wounds From Necrotizing Fasciitis: A Case Study.

Abstract

Ms. S was a 50-year-old woman hospitalized with necrotizing fasciitis from a labial abscess. After several surgical interventions wound debridements were performed consecutively for 6days. She was left with extensive full thickness tissue destruction of her abdomen, bilateral groin areas, and complete displacement of skin over her mons pubis. Wounds related to necrotizing fasciitis can be especially challenging to manage, especially when the perineal region is involved. Due to the location of such wounds, it can be difficult to maintain dressings, including negative pressure wound therapy with instillation devices (NPWTi). Ms. S. also had a history of uncontrolled diabetes mellitus, which can hinder wound healing. The Wound, Ostomy and Continence (WOC) nurse was consulted on day 6 of Ms. S's admission, for application of NPWTi. Complex NPWTi dressings were completed in the operating room (OR), 2 times weekly for 2weeks. When Ms. S was transferred from the intensive care unit to the surgical unit, NPWT dressings with instillation were used but later converted to standard NPWT, changed twice weekly by the WOC nurse. Dressings were changed at the bedside until day 29 of her admission. The management of Ms. S's extensive wounds was successful, and her wounds were closed by plastic surgery on day 29 of her admission. Ms. S was the first patient at our hospital with extensive wounds from necrotizing fasciitis to undergo surgical closure of her wounds during the same hospital admission.