Large Flap Preservation in a Patient With Extensive Necrotizing Fasciitis
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Abstract: Necrotizing fasciitis is a rare yet rapidly progressive life-threatening soft tissue infection. Historically, radical excision (including skin) along with broad-spectrum antibiotics has been the treatment regimen of choice. The authors report a patient treated in the burn unit with extensive necrotizing fasciitis in whom large skin flap preservation was achieved. The staple treatment of necrotizing fasciitis is early recognition, diagnosis, and complete necrosectomy. This process often leads to unnecessary resection of all overlying skin beyond the sentinel region of infection. To the authors’ knowledge, the preservation of large skin flaps in patients with necrotizing fasciitis has not been reported in the literature.
From the Department of Surgery, Wright State University, Boonshoft School of Medicine
Address correspondence to:
Travis L. Perry, MD
Wright State University, Boonshoft School of Medicine
Department of Surgery
One Wyoming St., 7800 WCHE
Dayton, OH 45409
Phone: 937-208-2177
Email: Travis.perry@wright.edu
Necrotizing fasciitis is a soft tissue infection that travels along a plane between the fascia and deep subcutaneous tissues. Aggressive and radical excision of all purulent and necrotic tissue must be completely excised without reservation eliminating further migratory spread of infection. In the past, total radical excisions may have included complete removal of all overlying skin.1 More recent studies have classified the degrees of skin viability,2 which are very similar to assessing burn injury zones of coagulation, stasis, and hyperemia. These observations take a closer look at the pathophysiological signs of skin flap viability. This may serve as a viable adjunct to efficiently optimizing perioperative wound management. The following report illustrates the clinical outcome of a patient who underwent radical excision of necrosis while achieving skin flap preservation. The purpose of this report is to describe our burn center’s surgical approach to performing a complete necrosectomy with large skin flap tissue preservation in a patient with necrotizing fasciitis.
