The Skin-Sparing Debridement Technique in Necrotizing Soft-Tissue Infections: A Systematic Review

Approaches to Surgical Debridement in Necrotizing Soft Tissue Infections: Outcomes of an Animated, Interactive Survey

“…This advice is based on expert opinion from clinicians well known with the surgical treatment of patients with NSTI, and the view that resecting non-necrotic skin does not improve source control, but does increase morbidity [ 12 , 19 , 20 ]. However, despite early promising results, [ 21 ] the superiority (or non-inferiority) of a skin-sparing approach in comparison to a classic en bloc approach is not proven, and opponents may fear inadequate source control when using this approach [ 13 ]. This latter was indeed mentioned as a reason to not perform a skin-sparing approach in this study, as well as inertia of previous practice (being trained to resect red skin) and lack of outcome expectancy.…”

“…More recently, a skin-sparing approach to debridement was proposed, in which all potentially viable skin above the affected fascia is preserved, in order to decrease final scar size and scar-related problems (contractures, pain, appearance) [ 11 , 12 ]. Although there is currently no convincing evidence for the superiority of either of these approaches, the skin-sparing approach has been adapted as the preferred approach in the Dutch guideline on NSTI [ 13 , 14 ]. This guideline advises to ‘only remove non-vital skin and preserve all vital skin,’ to ‘preserve skin when its vitality is unsure,’ and to use a skin-sparing approach as described by Tom et al [ 12 ] This has likely made most Dutch general surgeons and plastic surgeons, both proponents and opponents, aware of this novel skin-sparing approach.…”

A case report of Actinomyces-associated vulvar necrotizing soft tissue infection: Aspects of multidisciplinary care

“…Early surgical debridement is not only associated with decreased mortality but also reduce risk of septic shock, number of surgical debridements, and hospital length stay [8] , [9] . NSTIs often require a two-stage debridement as it is difficult to see all infected tissue grossly, and to return to the OR with a planned second stage debridement to salvage tissue and ensure a complete debridement [5] .…”

“…1 : C, D). Skin-sparing debridement has been shown to be non-inferior to en-bloc debridement for NSTI [5] .…”

Prodromal Fournier’s Gangrene: A Potential Opportunity for Early Intervention

“…9 While this technique shows promise in FG, where the multiple complex angles of the genitals and perineum can make closing large defects difficult, evidence supporting it remains sparse and its adoption should be judicious. 8 Post-debridement wound care is essential as it sets the stage for wound closure and reconstruction. Following definitive debridement, negative pressure dressings can be used to minimize painful dressing changes and promote a healthy wound bed for reconstruction or closure.…”