Early Treatment of Necrotizing Fasciitis Combining Skin-sparing Debridement and Negative-pressure Wound Therapy With Instillation and Dwell.

Necrotizing fasciitis is a life-threatening soft tissue infection requiring prompt diagnosis and aggressive treatment. Mortality rates have decreased due to improved diagnosis and management in recent years, necessitating a greater focus on preserving quality of life in survivors. Skin-sparing debridement has been championed by plastic surgeons as an alternative to traditional en bloc debridement. Negative-pressure wound therapy with instillation and dwell has also emerged as a treatment for necrotizing fasciitis. This treatment decreases bacterial bioburden in wounds; however, it is typically withheld in the setting of necrotizing fasciitis until wounds are free of infection and is rarely combined with skin-sparing debridement in this setting. This report describes 2 cases of necrotizing fasciitis of the hand and forearm treated with skin-sparing debridement and negative-pressure wound therapy with saline instillation and dwell. Both patients underwent multiple procedures before wound approximation and discharge. Patient A made a full recovery with no functional deficits or lasting morbidity. Patient B necessitated amputation of the right ring finger and experienced residual hand weakness but otherwise made a full recovery. This unique approach allowed delayed primary closure, minimized hand disfigurement and dysfunction, and prevented the need for additional wound coverage procedures.