Negative Pressure Wound Therapy for Necrotizing Fasciitis and Compartment Syndrome of the Upper Extremity — a case report

Abstract

Background: Necrotizing fasciitis (NF) is a lifethreatening infection of the subcutaneous tissues that spreads along the underlying fascia. Despite the early and aggressive surgical fasciotomy and necrectomy, its mortality rate is still high. In NF the negative pressure wound therapy (NPWT) shows good effects on wound healing and on the primary closure of the concomitant extended tissue defects.Case report: A 32-year-old male patient was admitted with a four-day history of fever (39.1 • C), pain, swelling, erythema of the right elbow and the upper arm. On admission, extensive erythema and swelling were seen on the right forearm, arm, and the pectoral region with superficial skin bullae. Based on the clinical symptoms and laboratory tests immediate surgery was indicated. Extended fasciotomy and necrosectomy were performed on the full extremity and pectoral region. Negative pressure wound therapy was started immediately afterward with -120 mmHg concomitantly with antibiotic therapy.Results: After five cycles of NPWT the patient recovered without needing any plastic surgical intervention. The functional and aesthetic results were excellent.Conclusion: In the case of extended NF of the upper extremity the aggressive surgery and NPWT are relatively safe and effective.