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 (39.1C), 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.