(CS-147) Use of Ultra-Thick Amniotic Membrane Allograft in the Management of Necrotizing Fasciitis
Thursday, May 16, 2024
7:30 PM – 8:30 PM East Coast USA Time
Introduction: Necrotizing fasciitis (NF) is a rapidly progressing soft-tissue infection involving necrosis of fascia and subcutaneous tissue that is associated with systemic toxicity and mortality rates as high as 35%.1, 2Immunosuppression, diabetes mellitus, alcoholism, end-stage renal disease, and chemotherapy have all been associated risk factors of increased mortality in NF.3 Standard of care includes thorough surgical debridement of the necrotic tissue, which can result in deep cavity wounds that often require adjunctive therapies to supplement soft tissue healing. Cryopreserved Amniotic Membrane (AM) derived from umbilical cord is one such therapy that has been increasingly used wound management due to its immunomodulatory and pro-regenerative properties.4-6
Methods: A case report of a patient with NF and a large cavity wound on the arm who was successfully treated with cryopreserved, ultra-thick amniotic membrane (AM) allograft†. Patient was admitted with left arm swelling and NF with septic shock, renal failure, and bacteremia. Medical history included Crohn's Disease, immunosuppression, chronic obstructive pulmonary disease, smoker, and chronic kidney disease.
Results: A 62-year-old female presented with NF on the left arm that previously received two surgical debridements including an initial incision and debridement followed by an extensive debridement with a negative pressure dressing applied to the 16x7 cm wound. After a third debridement of the infected and necrotic tissue, an AM allograft† with standard compressive Jones dressing was applied over the large cavity wound with exposed muscle and fascia (8x4 cm). By 6 weeks post-injury, the wound had completely epithelialized, and the patient demonstrated complete recovery of range-of-motion in the arm.
Discussion: Ultra-thick AM allograft was shown to support wound closure and functional recovery in a patient with a deep cavity wound complicated by NF.
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