Use of a bilayer biodegradable synthetic dermal matrix for the management of defects arising from necrotising fasciitis

Necrotising fasciitis is a life-threatening condition that arises from the rapid onset and progression of infection through the soft tissues, extending from the epidermis to the deep muscle layers.¹ The extent of injury can be severe and treatment for necrotising fasciitis can result in large skin defects, risk of limb amputation, and exposure of deep structures, such as bone and tendon, further complicating management of these complex wounds.

Diagnosis is not always straightforward, with patients often presenting with mild, diffuse symptoms and signs that do not immediately indicate the threat of rapid escalation of tissue destruction and the mortality risks associated with untreated necrotising fasciitis.² Education of frontline healthcare staff is therefore key to ensuring the urgent identification of likely symptoms.

Various types of necrotising fasciitis have been classified based on the number and/or type of associated organisms.^1,3,4 Type I is most common and is polymicrobial, in which anaerobic and aerobic bacteria proliferate synergistically. Type II is less common and is largely unimicrobial due to Group A, beta-haemolytic Streptococcus, occasionally in combination with a Staphylococcus and/or methicillin-resistant Staphylococcus aureus (MRSA). Type III is rare but has a high mortality rate of 30–40%, and is associated with Clostridium spp. and marine bacteria such as Vibrio, Aeromonas and Klebsiella spp. Opportunistic entry of bacteria can occur via the skin through relatively minor skin breaches, cuts and bites; however, it can also arise in areas of closed trauma, having been seeded by circulating bacteria from another portal of entry. It is more common in males and most commonly involves the extremities.⁵ Other risk factors and comorbidities include those who are older, immunocompromised, have diabetes or are obese (body mass index (BMI)>30kg/m²), although it can also be idiopathic in otherwise healthy individuals.³ Delays in clinical presentation and receiving timely medical attention may also increase the risk to patients who live in remote communities and/or those in lower socioeconomic communities.²