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Clinical Research
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Use of negative pressure wound therapy* in the adjunctive management of necrotizing fasciitis: analyzing the clinical outcomes First Author: Mona Baharestani, PhD Authors: Mona Baharestani, PhD, ANP, CWOCN, CWS, FCCWS, FAPWCA Necrotizing fascitis is a life-threatening rapidly progressing soft tissue infection resulting in extensive tissue defects and risk for limb loss. Most commonly, resultant wounds are managed with conventional moist gauze dressings applied 2-3 times daily. Exquisite pain, increased bacterial burden, prolonged length of stay (LOS) and high intensity staff and supply utilization are associated with care of these wounds. The sine qua non of managing this devastating necrotizing process is early diagnosis, immediate extensive surgical debridement, hemodynamic support, broad spectrum antibiotics, aggressive wound care and nutritional support. This study consisted of a retrospective review of 11 consecutive patients admitted with a diagnosis of necrotizing fascitis who were treated with NPWT. Eleven patients with 16 total wounds sites received NPWT. There were 6 sites affected, with the lower extremity comprising 63% of the total. Initial operative tissue cultures identified ?-hemolytic streptococcus in 82% of wounds. One hundred percent limb salvage was achieved and no patients expired. The average number of NPWT treatment days was 24.7, with a median of 21 days. Closure rate was 100% successful, with 71% receiving grafts and 29% requiring flaps. There were no direct complications associated with the NPWT* dressings. The average hospital LOS was 66.7 days, with a median of 45 days and a mode of 37 days. In comparing standard wound care to NPWT* in terms of supply costs and nursing time expenditures, standard care was found to be 2.25 times more costly. NPWT* is an efficacious, cost effective adjunct to the management of complex wounds associated with necrotizing fascitis. *V.A.C.ยช is a registered trademark of KCI, Inc. |
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