The Efficacy of Negative Pressure Wound Therapy and Acellular Dermis in the Presence of Extensive Tissue Loss: A Case Report on Necrotizing Fasciitis

Lead Presenter

Supporting Presenters

Gan Golshteyn DPM
Jessica Raque MD
Brian Harbrecht MD
Marie L. Williams DPM
Jean Holewinski DPM

Presented At

Abstract

The purpose of this case study is to investigate the efficacy of negative pressure wound therapy and acellular dermal matrix in the presence of extensive tissue loss status post necrotizing fasciitis of the leg. In this case, a 68-year-old Caucasian male with well-controlled diabetes with past medical history of mild liver cirrhosis, carrier of alpha 1- antitrypsin deficiency gene presented to AHMC trauma bay via air ambulance from Belize after being diagnosed with necrotizing infection from infected friction bullae, which began on his right fourth digit and tracked up the right lower extremity (foot to mid tibia). Patient was initially seen and treated surgically via sharp excisional debridement to the level of muscle and fascia by our hospital’s general surgery trauma team. Podiatry was consulted for surgical management of the right lower extremity after several debridements were performed. Under the care of our podiatric limb salvage team, patient underwent debridement of devitalized soft tissue once again with application of acellular dermis/amniotic grafts and placement of negative pressure wound therapy at 75mmHG. It must be noted that the patient had negative wound pressure placed since his initial treatment by the AHMC trauma team. Over the course of one month, patient was treated with NPWT until he was transferred via air ambulance back to this home state of Kentucky. Upon his return, patient underwent harvesting and application of split thickness skin graft, which were applied to the right lower extremity soft tissue defects. Over a period of two months after application of STSG approximately 90% of the extensive wound was healed. Currently, the patient is undergoing local wound care under the supervision of his spouse. This particular case study shows that in the presence of extensive soft tissue loss that NPWT can be a useful modality to lead to better outcomes and increased in likelihood of limb salvage.