Management of Massive Necrotizing Fasciitis Excision

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Patient History

A 39-year-old male presented with aggressive necrotizing fasciitis in the torso and extremities. The origin of the infected tissue was unclear. Infected and necrotic tissues were debrided across the entire torso, right axilla, right upper arm and forearm, bilateral flanks, bilateral groins, bilateral anterior thighs, scrotum, and base of the penis. The total excised area was 4,832 cm² with exposed fascia, muscle, and several ribs.

Treatment

Following debridement, a large amount of Restrata was applied to the wound and secured with staples. Abdominal pads were also used. A second application of Restrata Meshed was applied 19 days after the initial application. Viable granulation tissue was observed starting 21 days after the initial application of Restrata. Day 35, healthy granulation tissue sufficiently covered the left torso and bilateral thighs. The patient was taken to the OR for the first of many split-thickness skin graft (STSG) procedures in order to achieve full wound closure. This process of STSG was repeated for various parts including, the back, right torso, right upper thigh, right arm, right axilla, and genitalia.

Conclusion

Day 63, the patient was noted to be awake, alert, and capable of walking with assistance. Grafted regions estimated to have 95% graft take with minor graft loss due to location and body position. Most recently, 123 days after initial Restrata application, only minor openings remain with all other regions fully integrated.

Patient Presents Post Excision

Day 0

Initial application of Restrata Meshed

Day 7

1 week post application

Day 16

Granulation tissue present

Day 19

2nd application of Restrata Meshed on abdomen

Day 24

5 days after 2nd application

Day 35

Before STSG and After STSG

Day 35

Right arm developing healthy granulation bed

Day 38

Day 50

10 days after 2nd application of Restrata Meshed on right arm

Day 52

Day 59

5 days post STSG on right arm

Day 73

Day 123

Only minor openings remain with all other regions fully integrated

*Infection was controlled and no longer present at the time of the inital Restrata application.

**Disclaimer: Restrata has not been studied in wounds that extend into the tendon, muscle, joint capsule, or bone. Restrata should not be applied until excessive exudate, bleeding, acute swelling, and infection is controlled. Please refer to the Instructions for Use for a full list of indications, contraindications, precautions, and warnings.

MKG-30164

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Traumatic Gunshot Wound

After 3 applications, Restrata helped to provide a better-granulated tissue base for a STSG in this complex wound.

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