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

Garcia NM, Cai J. Aggressive soft tissue infections. Surg Clin North Am. 2018; 98:(5)1097-1108

Harbrecht BG, Nash NA. Necrotizing soft tissue infections: a review. Surg Infect (Larchmt). 2016; 17:(5)503-509

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

Yadav S, Rawal G, Baxi M. Vacuum assisted closure technique: a short review. Pan Afr Med J. 2017; 28

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

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

Goldstein EJ, Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007; 44:(5)705-710

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

Neeki M, Dong F, Au C Evaluating the laboratory risk indicator to differentiate cellulitis from necrotizing fasciitis in the emergency department. West J Emerg Med. 2017; 18:(4)684-689

George ME, Rueth NM, Skarda DE Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection. Surg Infect (Larchmt). 2009; 10:(1)21-28

Voros D, Pissiotis C, Georgantas D Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection. Br J Surg. 1993; 80:(9)1190-1191

Roje Z, Roje Ž, Matić D. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. World J Emerg Surg. 2011; 6:(1)

McCallon SK, Weir D, Lantis JC Optimizing wound bed preparation with collagenase enzymatic debridement. J Am Coll Clin Wound Spec. 2014; 6:(1–2)14-23

Marinis A, Voultsos M, Grivas P Vacuum-assisted therapy accelerates wound healing in necrotizing soft tissue infections: our experience in two intravenous drug abuse patients. Infez Med. 2013; 21:(4)305-311

Arslan E, Ozturk OG, Aksoy A, Polat G. Vacuum-assisted closure therapy leads to an increase in plasma fibronectin level. Int Wound J. 2011; 8:(3)224-228

Hasan MY, Teo R, Nather A. Negative-pressure wound therapy for management of diabetic foot wounds: a review of the mechanism of action, clinical applications, and recent developments. Diabet Foot Ankle. 2015; 6:(1)

Gabriel A, Kahn KM. New advances in instillation therapy in wounds at risk for compromised healing. Surg Technol Int. 2014; 24:75-81

Xu R, Xia H, He W Controlled water vapor transmission rate promotes wound-healing via wound reepithelialization and contraction enhancement. Sci Rep. 2016; 6:(1)

Philbeck TE, Whittington KT, Millsap MH The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage. 1999; 45:(11)41-50

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

02 February 2021
Volume 5 · Issue 1



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.


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.


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.


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

Register now to continue reading

Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Access to clinical or professional articles

  • New content and clinical updates each month