3 Year Retrospective Case Series with Reconstruction of Necrotizing Fasciitis Utilizing Preserved Hypochlorous Acid (pHA) Preserved Wound Solution

Introduction: Necrotizing fasciitis is an accelerated deteriorating subgroup of necrotizing soft-tissue infections (NSTI) resulting in necrosis of the fascia, muscle, and subcutaneous tissue.1,2 Necrotizing fasciitis poses significant complications and results in high rates of sepsis and mortality. When infection of this nature affects the genitals and perineum, it is called Fournier's gangrene. Early diagnosis, aggressive surgical resection, and adequate antimicrobial therapy have been shown to reduce mortality secondary to necrotizing fasciitis. We demonstrate a comprehensive treatment plan utilizing preserved hypochlorous acid (pHA) solution in cases of necrotizing fasciitis followed by varied reconstructive surgical techniques. Methods: Data was collected by retrospective review of patients with necrotizing soft-tissue infection, including Fournier’s gangrene, treated with surgical excision and plastic surgical complex closure and flap techniques at one academic hospital from May 2021 to May 2024. 7 patients were recognized by these criteria. Operative techniques and perioperative protocols were examined.  In addition, patients’ demographics, comorbidities, and operative cultures were reviewed.  Outcomes were assessed in the outpatient wound center based on post-operative complications and healing outcomes of the surgical sites. Results: 7 patients with necrotizing fasciitis requiring surgical excision and plastic surgical wound closure were examined.  Dilutehypochlorous acid preserved solution irrigation was used intraoperatively to decrease biofilm burden and optimize the wound bed prior to reconstruction. The most common reconstructive techniques were local advancement flaps complex closure, and skin grafts.  2 patient underwent reoperation for wound dehiscence. 2 patients healed from their necrotizing fasciitis excision and reconstruction without reoperation. 1 patient experienced minor (5%) wound dehiscence treated with local wound care. 3 patients were lost to outpatient follow-up but were discharged without known wound complications. Cultures were sent from all 6 patients which revealed growth of various pathogens. Discussion: Necrotizing fasciitis excision, irrigation with pure hypochlorous acid (pHA) preserved solution irrigation, and perioperative care were standard for all patients but reconstructive procedure selection remained variable.  High surgical success rates were seen with this integrated protocol.  Wound bed preparation with pHA is an effective technique for improving outcomes after plastic surgical excision of necrotizing fasciitis and reconstruction. References:1.Bosshardt TL, Henderson VJ, Organ CH Jr. Necrotizing soft-tissue infections. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available from: https://www.ncbi.nlm.nih.gov/books/NBK6876/ 2.Wallace HA, Perera TB. Necrotizing Fasciitis. [Updated 2023 Feb 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430756/