![]() To decrease the likelihood of skin flap necrosis, and to facilitate skin flap mobilization for direct wound closure in the necrotizing fasciitis patient who had undergone dermatotraction, the authors applied extended NPWT over the dermatotraction device during treatment of the open wound. Although it provides an attractive alternative for the necrotizing fasciitis patient in poor general condition, dermatotraction has remained an alternative surgical option to date. Dermatotraction in the necrotizing fasciitis patient may therefore be ineffective, and the traction can disturb circulation in the stiff skin flaps, resulting in skin necrosis. Whereas the fasciotomy wound in compartment syndrome is supple, the fasciotomy wound in necrotizing fasciitis is usually scarred, and stiffer than the wound in compartment syndrome due to prolonged wound preparation. Dermatotraction has been used to close open fasciotomy wounds in compartment syndrome. Successful dermatotraction can close fasciotomy wounds directly, and may restore the function and appearance of the fasciotomy wound site. Dermatotraction is a surgical option that gradually approximates the margins of large wounds with a traction device. Although NPWT can improve a wound’s condition, it cannot close it completely, so other operations are required for wound coverage. Negative pressure wound therapy (NPWT) has been used to control chronic wounds as it increases tissue perfusion and decreases wound edema. Skin grafting usually requires a long time to heal, as the wound bed is often dirty and unstable. However, surgical options are often limited as poor patient condition restricts the use of time-requiring extensive surgeries such as local flap or free flap coverage. A delay in coverage of this residual open wound may result in delayed infection, debilitating patient condition, and even generalized sepsis. However, even after proper management to control infection, a large open wound usually remains to cover this, surgical intervention such as skin graft, local flap, or free flap is required. ![]() Early diagnosis with prompt surgical debridement is essential in management of this rapidly progressing disease. Necrotizing fasciitis is a rapid progressive infection of the subcutaneous tissue or fascia that usually occurs in the groin and lower extremities. This method can be another good treatment option for the NF patient with large open wounds whose general condition is unsuitable for extensive reconstructive surgery. ConclusionsĮxtended NPWT-assisted dermatotraction advances scarred, stiff fasciotomy wound margins synergistically in NF and allows direct closure of the wound without complications. The patients were followed up for 18.3 months on average and showed satisfactory results without wound recurrence. Two Fournier’s gangrene patients underwent multiple sets of treatment and finally achieved secondary wound closure with skin grafts. One patient with a chest wall defect underwent latissimus dorsi musculocutaneous flap coverage, with primary closure of the donor site. ResultsĪfter the first set of extended NPWT-assisted dermatotraction procedures, the mean wound area was significantly decreased (658.12 cm 2 to 29.37 cm 2 p = 0.002), as five out of eight patients achieved direct wound closure. The clinical outcome was assessed based on wound area reduction after treatment and by the achievement of direct wound closure. The negative pressure of the NPWT was set at a continuous 100 mmHg by suction barometer. The sponge was three times wider than the wound width, and the transparent covering drape almost encircled the anatomical wound area. Next, the extended NPWT was applied over the wound. After serial wound preparation, dermatotraction was applied in a shoelace manner using elastic vessel loops. ![]() MethodsĪ retrospective case series of eight patients with NF who underwent open fasciotomy was approved for the study. The authors present the clinical results, followed by a discussion of the clinical basis of extended NPWT-assisted dermatotraction. The authors use extended negative pressure wound therapy (NPWT) as an assist in dermatotraction to close open NF fasciotomy wounds. However, dermatotraction for scarred, stiff NF fasciotomy wounds is often ineffective, resulting in skin necrosis. Dermatotraction can restore the function and appearance of the fasciotomy wound and is less invasive in patients with comorbidities. The surgical options to cover these wounds are often limited by the patient condition and result in suboptimal functional and cosmetic wound coverage. ![]() Necrotizing fasciitis (NF) is a rapid progressive infection of the subcutaneous tissue or fascia and may result in large open wounds.
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