References

Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014; 51:(8)344-362 https://doi.org/10.1067/j.cpsurg.2014.06.001

Garcia NM, Cai J. Aggressive soft tissue infections. Surg Clin North Am. 2018; 98:(5)1097-1108 https://doi.org/10.1016/j.suc.2018.05.001

Harbrecht BG, Nash NA. Necrotizing soft tissue infections: a review. Surg Infect (Larchmt). 2016; 17:(5)503-509 https://doi.org/10.1089/sur.2016.049

Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing as treatment of soft tissue damage in open fractures [article in German]. Unfallchirurg. 1993; 96:(9)488-492

Huang C, Leavitt T, Bayer LR, Orgill DP. Effect of negative pressure wound therapy on wound healing. Curr Probl Surg. 2014; 51:(7)301-331 https://doi.org/10.1067/j.cpsurg.2014.04.001

Yadav S, Rawal G, Baxi M. Vacuum assisted closure technique: a short review. Pan Afr Med J. 2017; 28 https://doi.org/10.11604/pamj.2017.28.246.9606

Kim PJ, Attinger CE, Steinberg JS The impact of negative-pressure wound therapy with instillation compared with standard negative-pressure wound therapy: a retrospective, historical, cohort, controlled study. Plast Reconstr Surg. 2014; 133:(3)709-716 https://doi.org/10.1097/01.prs.0000438060.46290.7a

Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009; 208:(2)279-288 https://doi.org/10.1016/j.jamcollsurg.2008.10.032

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Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004; 32:(7)1535-1541 https://doi.org/10.1097/01.CCM.0000129486.35458.7D

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Negative pressure wound therapy
Hard-to-heal wounds
Diabetic foot ulcers
Wound infections

Vacuum sealing drainage with instillation in the treatment of necrotising soft-tissue infection: a retrospective analysis

02 February 2021
Practice
02 February 2021
Volume 5 · Issue 1

Abstract

Objective:

Necrotising soft-tissue infection is a rare but life-threatening infectious disease with high morbidity and mortality. It is typically caused by toxin-producing bacteria and characterised clinically by a very rapid progression of the disease with significant local tissue destruction. In this study, we intend to explore effective wound management to control the invasive infection and to decrease the high mortality.

Method:

This retrospective analysis explored the wound management and mortality in patients with necrotising soft-tissue infection. Extensive debridement, vacuum sealing drainage (VSD) with normal saline instillation combined with broad-spectrum or sensitive antibiotics, and supportive therapies were used.

Results:

All 17 patients included in the analysis survived. The microbiology of 11 patients was found to be polymicrobial. Of the patients, 14 were discharged with completely healed wounds and three were transferred to a local hospital after the systemic and invasive wound infection was controlled.

Conclusion:

Our experiences revealed the outstanding effect of VSD with instillation in removing the debris of necrotising tissue on the wound bed, in the continual and complete drainage of wound exudates, and in prompting wound healing.

Necrotising soft-tissue infection is a rare but life-threatening infectious disease with high morbidity and mortality. It is typically caused by toxin-producing bacteria and characterised clinically by a very rapid progression of the disease with significant local tissue destruction.1 It is further subdivided into necrotising fasciitis (or Fournier gangrene if the perineum regions are involved), necrotising myositis, necrotising adipositis and cellulitis. Rather than a single tissue infection, necrotising soft-tissue infection is commonly an infectious necrosis involving multiple tissues.

Due to its rapid progression and devastating fatal complications, necrotising soft-tissue infection is considered as an emerging and critical situation by physicians.2 Major treatments include wound management, broad-spectrum or sensitive antibiotics according to bacterial susceptibility test results, and supportive therapies. Among these therapies, wound care is the most important and most difficult because it is impossible to completely remove infectious and necrotic tissues; thus invasive infection is hard to control.3 Invasive wound infection may lead to sepsis, multiple organ dysfunction syndrome (MODS) and even death.2

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debridement
necrotising soft-tissue infection
vacuum sealing drainage with instillation
wound healing