Use of Negative Pressure Wound Therapy With Instillation and Dwell Time in All Phases of Care for the Management of Complex, High-risk Wounds: Two Case Reports of Necrotizing Fasciitis.

INTRODUCTION

Necrotizing fasciitis is a devastating infectious process associated with high mortality and morbidity rates. Medical and surgical interventions are necessary for survival. Negative pressure wound therapy (NPWT) has been shown to be beneficial in wound and graft care in these patients. Recently, NPWT has evolved to include instillation and dwell time (NPWTi-d) with encouraging results. However, no studies have examined the efficacy of NPWTi-d in graft care. The authors report the first 2 cases of necrotizing fasciitis with resulting complex wounds in which NPWTi-d was utilized during all phases of care (including after graft transfer) with excellent outcomes.

CASE REPORT: Two patients presented with histories of sustaining external trauma to their lower extremities with subsequent development of erythema, edema, and pain. Diagnosis of necrotizing fasciitis was made through history and physical examination findings, supported by LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) scores of greater than or equal to 6, and confirmed upon review of final surgical pathology. Limb salvage was pursued successfully in both cases via aggressive irrigation/debridement, skin grafting, and NPWTi-d application. The NPWTi-d was utilized during all phases of care (after irrigation/debridement procedures and as the split-thickness skin graft bolster) and was associated with excellent graft take without the need for repeat operative intervention. Both patients' wounds healed without complication, and the patients resumed prior activity levels.

CONCLUSIONS

Despite offering some advantages, NPWTi-d has yet to be utilized in graft management. The authors postulate that NPWTi-d may offer some advantages in caring for skin grafts and could aid in graft survivability and take in certain clinical scenarios. Higher level evidence is needed to determine the true indications and contraindications of NPWTi-d.