(CS-154) Necrotizing Fascitis: Never Throw in the Towel Too Early

This research focuses on a case study with a patient who developed an extensive necrotizing fasciitis (NF) infection in her right lower extremity. Patient is a 52 year old female with past medical history of CHF, HTN, AKI, and DMII. She was admitted to the hospital with a CRP > 19, WBC 8.7 and extensive soft tissue infection to the right lower extremity. She had previously recovered from an ipsilateral hallux amputation due to osteomyelitis less than 1 year from this NF infection.  

Methods: This work evaluates the clinical progress of one patient over a period of 16 months from August 2022 to December 2023. She underwent multiple washouts with deep debridements in the operating room extending from the toes to the proximal lateral leg. Extensive use of skin substitutes in the operating roomwith varying combinations of bedside wound care products were utilized to ultimately save the right lower extremity.

Results:

She was put on long term ceftriaxone. Wound and abscess cultures all grew Group B Streptococcus. Vascular workup showed strong, triphasic pulses adequate for healing. Halfway through recovery, complications of an Achilles tendon rupture with calcaneal osteomyelitis led to further surgery. Patient was able to successfully recover from her infection with life and limb intact. 

Discussion:

Multiple specialties such as Vascular Surgery, Infectious Disease, and Hospital Medicine deemed the patient a high risk for limb loss. However with proper infection control, the use of skin substitutes, negative pressure wound therapy and continued debridements, the limb was salvaged. This paper discusses the surgical and wound care techniques along with the types of grafts utilized for this patient.