Necrotizing fasciitis: case study of a nursing dilemma.

Necrotizing fasciitis usually manifests as a low grade cellulitis that quickly deteriorates to a limb and life threatening soft tissue infection. Immediate surgical debridement is essential, after which wound management becomes the nurse's primary concern. Case #1 reports on a 72 year old female who, upon presenting to the ER with a "sore bottom," subsequently had these diagnoses: (1) anal-rectal abscess, (2) Fournier's gangrene, (3) ulcerative enterocolitis, (4) chronic blood loss/anemia, and (5) protein caloric malnutrition. After debridement, her anal-rectal wound extended from labia to left buttocks. Care was multidisciplinary and included applying a water based aloe gel and saline soaked gauze twice a day. After 45 days, the wound exhibited a pink base with granulation tissue and contraction of the wound edges. Case #2 reports on a 48 year old male with seroma of the left leg secondary to a crush injury. Within three days he developed deep vein thrombosis in that leg as well as two large seroma cavities on either side of the thigh. Care included packing with the aloe gel and saline soaked sponges. Two weeks after admission, the anterior wound was covered with a split thickness skin graft while partial closure of the lateral cavity was attempted unsuccessfully with retention sutures. After five weeks, healing was complete for the anterior wound and 95 percent complete for the posterior wound.