Necrotizing Fasciitis

[carl5480]

It seems that my area has a growing number of these cases recently, and the preferred treatment is to remove extremely large amounts of tissue, which results in wounds that are then left open for a period of weeks to months (often with daily or twice daily dressing changes), usually until skin grafting is a viable option. Obviously, due to the nature of the condition and the toxins that are released, being too conservative surgically wound be life- and limb-threatening. I suppose I'm just wondering if anyone has seen any alternative treatments to nec fasc other than leaving the patient with huge open wounds long-term?

[MoopleRN]

I'm not aware of any alternative treatments. I think most surgeons try to be as conservative as possible for obvious reasons. I've only seen one case that involved a disposable razor... the patient's outcome was positive, btw.

[xoemmylouox, ASN, RN]

It's tough to see a person lose so much of their body, but I think this is the most effective treatment for this.

[Silverdragon102, BSN]

My understanding that even huge doses of antibiotics do not stop it. Saw one once that started approx size of a 25 cent coin and by the time the doctor saw it it was bigger and she immediately referred to surgeon and patient was in theatre having it removed and was bigger even then and this was all within 6 hours of admission

[loriangel14, RN]

I have had two patients with this and they did have large amounts of tissue removed surgically and then had wound vac dressings put on. One recovered and went home, one developed complications and died.

[delilas]

My first case involved a woman who just had a lot of pain in her little finger, and came to an urgent care after only a day of pain - her finger finally began turning red and swollen. With her initial surgery, it had already spread to her hand, so she was amputated about an inch past her wrist.

She was dosed on heavy antibiotics (which never seem to do much) and within a day, they found signs of it spreading up to her antecube. They ended up finally amputating at the shoulder to try to head it off as best they could. She ended up surviving, but I'll never forget that case.

I had a case just a couple weeks ago too, and I was terribly scared for him, because it was in his neck...which naturally, there isn't a lot of area to cut away there. After his initial debridement, we used a kickass wound vac on him that sprayed sulfamylon in for three minutes every two hours. We had a lot of other touch and go moments because his kidneys failed from toxins and septicemia, but three weeks later, we were able to send him home.

Necfasc is evil, there are no buts about it. Believe me, {most} docs won't excise large amounts of tissue for the fun of it; but if you don't get ahead of necrotizing fasciitis, it'll spread so fast your head will spin.

[Caffeine_IV]

I don't know of any. Patients I've had with it were grateful to have limbs spared that they didn't complain about the wound.