Surgery complemented by
antibiotics forms the backbone of the successful management of
necrotizing fasciitis. But it will be very difficult to clear away extensive necrotizing tissue thoroughly in
critically ill patients when their vital signs are unstable. The authors report the case of a 33-year-old woman who had extensive
necrotizing fasciitis of the right lower limb with
septic shock. The patient was severely anemic and
malnutrition and had been given conservative
debridement at bedside, that is, only detached necrotizing tissues was taken away while some other necrotizing tissue still remained, so that the skin tissue within the same area could be saved as much as possible. After
debridement, negative pressure was applied
at 125 mm Hg. Broad-spectrum
antibiotics and effective supplementation were also complemented, thus controlling the
septic shock. All necrotizing tissues were detached, and the sparing vital skin on necrotizing fascia was preserved successfully after negative pressure treatment. The patient was finally saved. In conclusion, negative pressure treatment may help diminish toxin absorbance, detach
gangrene tissue, and preserve sparing vital tissue. This case suggests the value of combined use of negative pressure
therapy and conservative
debridement in
critically ill patients with extensive
necrotizing fasciitis.