Ten-year follow-up of a case of necrotizing fasciitis successfully treated with negative-pressure wound therapy, dermal regeneration template application, and split- thickness skin autograft

Abstract

Introduction: Necrotizing fasciitis is a rapidly progressive and often fatal infection of the fasciae and subcutaneous tissues.

Patient and methods: In this case report, we present the treatment of a 63-year-old patient suffering from diabetes mellitus, who was admitted to the emergency unit for severe right gluteal pain, which had begun 24 hours before admission. Cutaneous symptoms, oliguria, metabolic acidosis, acute renal failure, severe hypotension, and tachycardia occurred, and the patient was admitted to Intensive Care a few hours after initial admission. The patient underwent a debridement of gluteal, abdominal, lower-thoracic, and upper thigh regions. Biopsy of fascia lata confirmed the suspected diagnosis of necrotizing fasciitis. Treatment included prompt surgical debridement, negative-pressure wound therapy, and dermal regeneration template application with fibrin glue, and subsequent split-thickness skin autografting.

Results: After 10 years, elasticity of the skin and limb mobility are comparable to that in non-injured areas, and the patient is pain free.

Conclusion: In our opinion, this combination should be a treatment of choice for large wounds in the patients with NF with multiple comorbidities.

Keywords:

• Necrotising fasciitis
• plastic surgery
• negative pressure wound therapy
• dermal template
• skin-grafting

Disclosure statement

The authors declare no conflict of interest.

Written informed consent was obtained from the patient for publication of this case report and accompanying images.