Authors (including presenting author) :
Liu KWB, Li YN, Sum WK, Leung LC, Lam KY, Chan LY, Chan CM, Leung WY
Affiliation :
Orthopedics & Traumatology, North District Hospital
Introduction :
Necrotizing Fasciitis is a rapidly progressive infection that destroys deep soft tissues with high complications and mortality rate.
Objectives :
To illustrate successful hybrid healing journey of post Necrotizing Fasciitis (NF) upper dominant functional limb salvage with medial sural artery perforator (MSAP) flap reconstruction while donor site necrosis healing by biodegradable temporizing matrix (BTM).
Methodology :
Young Chinese male was suffering from dominant hand NF. Uncontrolled infection was identified in dorsum metacarpal region and nearly breached to thenar compartment. Extensive fasciotomy and debridement were performed while all extensor tendons were exposed with intact paratendon. After infection was controlled with targeted antibiotics. MSAP flap was done to seal up defects. Unfortunately, it was complicated with partial dehiscence. Simultaneously, donor site necrosis was managed by BTM application. Negative Pressure Wound Therapy (NPWT) was applied to cope with flap salvage and matrix integration. Significant clinical outcomes were elucidated by successful flap completely anchorage and granulating tissue prompt proliferation.
Result & Outcome :
Wounds were completely healed after two months in patient stay and four months outpatient nurse wound care service follow up. Patient could regain all fingers full range of motion and full grip power after vigorous physiotherapy. There were no readmission and major amputation needed. Application of BTM offers a safe and reliable reconstructive option in patients with complex wounds who are unfit for more complex surgery.
In conclusion, this case study demonstrated the success application of NPWT in flap dehiscence salvage and dermal matrix integration. We have shown that hybrid advanced wound care methodology indeed can be successful in salvaging limbs and reducing risk of major amputation. Besides, utilization of BTM appears robust and is showing promise as a useful reconstructive tool.
