Skin-Sparing Débridement for Necrotizing Fasciitis in Children:

Practical Review of Necrotizing Fasciitis: Principles and Evidence-based Management

Necrotizing fasciitis is a severe, life-threatening soft tissue infection that presents as a surgical emergency. It is characterized by a rapid progression of inflammation leading to extensive tissue necrosis and destruction. Nonetheless, the diagnosis might be missed or delayed due to variable and nonspecific clinical presentation, contributing to high mortality rates. Therefore, early diagnosis and prompt, aggressive medical and surgical treatment are paramount. In this review, we highlight the defining characteristics, pathophysiology, diagnostic modalities, current principles of treatment, and evolving management strategies of necrotizing fasciitis.

The Skin-Sparing Debridement Technique in Necrotizing Soft-Tissue Infections: A Systematic Review

BACKGROUND

Skin-sparing debridement (SSd) was introduced as an alternative to en bloc debridement (EBd) to decrease morbidity caused by scars in patients surviving Necrotizing soft-tissue infections (NSTI). An overview of potential advantages and disadvantages is needed. The aim of this review was to assess (1) whether SSd is noninferior to EBd regarding general outcomes, that is, mortality, length of stay (LOS), complications, and (2) if SSd does indeed result in decreased skin defects.

METHODS

A systematic literature search was performed according to the PRISMA guidelines. All human studies describing patients treated with SSd were included, when at least of evidence level consecutive case series. Studies describing up to 20 patients were pooled to improve readability and prevent overemphasis of findings from single small studies.

RESULTS

Ten studies, one cohort study and nine case series, all classified as poor based on Chambers criteria for case series, were included. Compared to patients treated with EBd, patients treated with SSd had no increased mortality rate, LOS or complication rate. SSd-treated patients had a high rate (75%) of total delayed primary closure (DPC) in the pooled case series.

CONCLUSION

The current available evidence is of insufficient quality to conclude whether SSd is noninferior to EBd for all assessed outcomes. There are suggestions that SSd may result in a decreased need for skin transplants, which could potentially improve the (health related) quality of life in survivors. Experienced surgical teams could cautiously implement SSd under close monitoring, ideally with uniform outcome registry.

Necrotizing fasciitis complicated with multiple organ dysfunction syndrome after breast augmentation with fat from the waist and lower extremities: a case report

Necrotizing fasciitis (NF) is a rapidly progressing soft tissue infection with a mortality rate as high as 30% to 50%. However, the incidence rate of NF after liposuction is extremely low. In the current case report, we describe a woman with NF who developed multiple organ dysfunction syndrome (MODS) after fat acquisition. The aim of this paper is to summarize the management of these patients. After debridement and drainage, correction of multiple organ failure, and plastic surgery, the patient’s organ and lower limb functions improved to a normal level. Early diagnosis, early operative treatment, and correction of systemic abnormalities are the keys to successful recovery of patients with NF complicated with MODS after liposuction.