Serial irrigation and debridement with the use of Kerecis in the treatment of necrotizing fasciitis: A case report.

Introduction: Necrotizing fasciitis is a life-threatening infection that requires emergent irrigation and radical debridement. One of the challenges surgeons often encounter is gaining adequate soft tissue coverage of the defects that remain after debridement. Kerecis SurgiClose (Coloplast, Denmark), a fish skin xenograft, is one option for wound coverage. This has demonstrated potential for fostering an environment beneficial for wound healing in various types of wounds. Case presentation: A 39-year-old female presented to the emergency department with a one-week history of left knee pain after a fall. She had a wound on the anterior knee, which began to develop erythema. Necrotizing fasciitis was diagnosed with the patient's Laboratory Risk Indication of Necrotizing Fasciitis (LRINEC) score of 10. She was started on antibiotics and was taken to surgery. She underwent debridements until a bed of healthy tissue was appreciated. Kerecis SurgiClose was applied over the defect which helped create a healthy tissue bed prior to placing a skin autograft. After grafting, daily dressing changes started and evident healing in the recipient site was seen. Conclusion: This case demonstrates the importance of early diagnosis of necrotizing fasciitis, as well as the utility of fish xenografts in wound coverage once a healthy tissue environment is established. These xenografts are used for many types of wounds, however there is a paucity in the literature supporting their use in necrotizing soft tissue infections. The properties of these grafts potentiate various aspects of healing and show promising results in the healing of deep soft tissue voids.