Wound Management of Severe Necrotizing Fasciitis

Introduction: 57-year-old Caucasian male with a past medical history of RCA STEMI and reduced EF%, admitted to the hospital with diagnosed necrotizing fasciitis infection involving his perineum, scrotum, pubis, and right flank. LRINEC score of 9 upon admission.  The organism of infection found to be Group A streptococci. The patient experienced a cardiac arrest before urgent operating room (OR) debridement and required stabilization and ROSC in the ICU. Patient required OR procedure for debridement from necrotizing soft tissue infection resulting in large tissue deficit of the right flank and removal of scrotum.Methods:The patient required continued debridement’s in the OR for an extensive loss of tissue. The advanced wound care nurse practitioner/Certified Wound Ostomy Continence Nurse was consulted for application and maintenance of the negative pressure wound treatment (NPWT) dressing. The difficulty encountered with the loss of the scrotum to maintain testicles appropriately. The color of the testicles indicated poor perfusion with eventual need for bilateral orchiectomy. Advanced modalities with skin substitutes began with the fourth trip to the OR utilizing temporary synthetic temporizing skin matrix over the right and left flank wounds. On the fifth surgical event acellular matrix dressing was applied to the penile shaft and pubis. The maintenance of the NPWT dressings changes were completed in the OR with the surgical team and the NP/CWOCN twice a week related to the extensive nature of the wound.  Results:Hospital day #49 the patient was taken to the OR and skin grafting completed of the patient’s wounds left flank and the distal portion of the right flank wound. A skin graft was applied to the penile shaft. NPWT applied after skin grafting was complete and left for 5 days before removal. NPWT applied to the wound and patient was discharged home on hospital day #56. Wound dressings with NPWT to be changed weekly in surgical clinic.Discussion: This poster presentation reviews the needs for wound care with a large tissue deficit related to necrotizing fasciitis infection with use of skin substitutes, NPWT, and eventual skin grafting.References: