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      A Case Report of Necrotizing Fasciitis Managed With the Application of Negative Pressure Wound Therapy to Achieve Better Wound Closure

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          Abstract

          Necrotizing fasciitis is a severe and potentially life-threatening infection of the soft tissues that involves the skin, subcutaneous fat, fascia, and muscle. It can rapidly spread and lead to tissue death, sepsis, toxic shock syndrome, cardiopulmonary failure, and even death, especially in patients with chronic diseases, immunocompromised status, or immobility. To control the spread of necrosis, prompt diagnosis and aggressive surgical intervention with radical debridement of the affected tissues are essential, along with the administration of broad-spectrum antibiotics and intensive care support, when required. The application of negative pressure wound therapy has been utilized in the management of acute and complicated wounds with good outcomes.

          Here, we present a case of an 82-year-old female who presented with fever, tachycardia, and hypotension with underlying comorbid conditions of diabetes mellitus, hypertension, and spinal stenosis. On further exploration, she was found to have necrotizing fasciitis involving the left gluteal region. The present article describes the use of a vacuum-assisted closure dressing as an adjunct to serial debridement in the treatment of severe necrotizing fasciitis.

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          Necrotizing Fasciitis

          Necrotizing fasciitis (NF) is among the most challenging surgical infections faced by a surgeon. The difficulty in managing this entity is due to a combination of difficulty in diagnosis, and also of early as well as late management. For the patient, such a diagnosis means prolonged hospital stay, painful dressings, an extended recovery, and in some unfortunate cases even loss of limb or life. Necrotizing fasciitis is a fairly common condition in surgical practice in the Indian context resulting in a fairly large body of clinical experience. This article reviews literature on MEDLINE with the key words “necrotizing,” “fasciitis,” and “necrotizing infections” from 1970, as well as from articles cross referenced therein. The authors attempt to draw comparisons to their own experience in managing this condition to give an Indian perspective to the condition.
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            A case report of successful treatment of necrotizing fasciitis using negative pressure wound therapy

            Abstract Rationale: Necrotizing fasciitis is a destructive tissue infection with rapid progression and high mortality. Thus, it is necessary that high-performance dressings be introduced as possibilities of treatment. Patient concerns: Female patient, 44 years of age, admitted to hospital unit complaining of lesion in the gluteal region and drainage of purulent secretion in large quantity followed by necrosis. Diagnoses: The diagnosis of necrotizing fasciitis was carried out with the computerized tomography examination result and its association with the patient's clinical condition. Interventions: Initially, successive debridements were carried out in lower limbs as well as primary dressing with enzymatic debriding action until indication of negative pressure wound therapy, for the period of 2 weeks in the right lower limb and for 5 weeks in the left lower limb, with changes every 72 h. Dressing with saline gauze was used at the end of this therapy until hospital discharge. Outcomes: After the use of negative pressure wound therapy, we observed the presence of granulation tissue, superficialization and reduction of lesion extension. The patient presented good tolerance and absence of complications. Lessons: Negative pressure wound therapy constituted a good option for the treatment of necrotizing fasciitis, despite the scarcity of protocols published on the subject.
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              Vacuum-assisted closure as a surgical assistant in life-threatening necrotizing fasciitis in children.

              Necrotizing fasciitis is a severe soft tissue infection that can involve skin, subcutaneous fat, fascia and muscle. It can result in devastating sequelae including tissue necrosis, sepsis, toxic shock syndrome, cardiopulmonary collapse and death. To control rapidly spreading necrosis, early diagnosis and aggressive surgical treatment with extensive radical debridement of the affected areas is necessary, as well as systemic administration of broad-spectrum antimicrobials and, very often, intensive care support.The subatmospheric negative pressure dressing has been previously used in acute and complex wounds management. The concept of using vacuum-assisted closure dressing as another management component is presented in the current article.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                28 September 2023
                September 2023
                : 15
                : 9
                : e46140
                Affiliations
                [1 ] Medicine, Jinnah Hospital Lahore/Allama Iqbal Medical College, Lahore, PAK
                [2 ] Medicine, Fauji Foundation Hospital/Foundation University Medical College, Rawalpindi, PAK
                [3 ] Medicine, Rawalpindi Medical University, Rawalpindi, PAK
                Author notes
                Article
                10.7759/cureus.46140
                10612989
                37900373
                aec63480-7f00-4683-813b-66782e6d2f6a
                Copyright © 2023, Afzal et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 28 September 2023
                Categories
                Plastic Surgery
                General Surgery
                Infectious Disease

                vacuum assisted closure (vac),plastic surgery,surgical debridement,methicillin resistant staphylococcus aureus (mrsa),negative pressure wound therapy,necrotizing fasciitis

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