The present case is of Mr. A who is a sixty-one year old who is a widower and his wife passed due to lung cancer and lives on his own. He has a history of a popliteal aneurysm which was repaired three years ago and embolectomy of right anterior tibia. He presented with redness, the area was warm and lower right leg was swollen and enlargement was progressive with fever and associated with severe pain. For the treatment surgical debridement is done after which wound care is an important aspect as it can otherwise lead to infection, septicemia and even death. The aim of the present academic paper is to examine the best available evidence for the same and critique with the level of care that was provided to the patient.
Necrotizing fasciitis is a disease which is severe, rare but it is extremely rare and is lethal as it spreads fast through the tissue spaces and can cause septic shock. It can lead to death if not treated properly and immediately, people with co-morbidities when affected have poor prognosis. There are many treatment modalities which have been explored by the healthcare professionals and most of the evidence for the wound care in necrotizing fasciitis is in the form of case reports or case studies. It is required that the condition is recognized as early as possible so that aggressive treatment can be started so that there can be positive health outcome and less disability. Due to the compromised nature of the blood vessels, ischemia and hypoxia hinders the distribution of antibiotics to the site of infection and conservative treatment does not have much value in the management of the disease (Misiakos et al., 2014). It is seen that along with other forms of management broad-spectrum antibiotics are better effective in the management of necrotizing fasciitis but the antibiotics are dependent on type of microorganism affecting the body.
At present, emergency surgical debridement of the tissues that are affected is the primary modality of the treatment and it is known to be lifesaving. It is recommended that it should be done as soon as possible and within first 24-hours after it is suspected and the extent depends on the extent of affect. In a study conducted it has been reported that conservative debridement is associated with higher relative risk of death and was 7.5 times in restricted primary debridement cases. Another study has reported that the mortality rate increases by nine times if the primary debridement surgery is conducted after twenty-four hours of getting symptoms (Roje et al., 2011).
Another study that was conducted as a case series in which thirteen patients with necrotizing fasciitis were treated and followed up and it was seen that mortality increased with delay in diagnosis and management method (Corona et al., 2016). The authors reflected that debridement of the wound should be done as soon as possible which should not be conservative but should be aggressive in nature and not conservative. It is critical that the management of the open wound is to be done with utmost care which is the result of radical debridement (Lee et al., 2014). One of the ways of wound care that can be done is by negative pressure wound therapy. Several randomized control studies have been conducted to measure the effectiveness of the negative pressure therapy with conventional moist dressing and it has been found to be more effective. Including all its advantages like increased cell proliferation, migration, increased blood flow, increased granulation tissue formation and removal of exudate but it has limited use in necrotizing fasciitis.
In a prospective case series that was conducted on patients those developed necrotizing fasciitis and they were followed till the time they either recovered or the extremities amputated to control the spread of infection.
Corona, P.S., Erimeiku, F., Reverté-Vinaixa, M.M., Soldado, F., Amat, C. and Carrera, L. 2016. Necrotising fasciitis of the extremities: implementation of new management technologies. Injury, 47, pp.S66-S71. https://doi.org/10.1016/S0020-1383(16)30609-X.
Lee, J.Y., Jung, H., Kwon, H. and Jung, S.N. 2014. Extended negative pressure wound therapy-assisted dermatotraction for the closure of large open fasciotomy wounds in necrotizing fasciitis patients. World Journal of Emergency Surgery, 9(1), p.29. https://doi.org/10.1186/1749-7922-9-29.
Misiakos, E.P., Bagias, G., Patapis, P., Sotiropoulos, D., Kanavidis, P. and Machairas, A. 2014. Current concepts in the management of necrotizing fasciitis. Frontiers in Surgery, 1, p.36. https://doi.org/10.3389/fsurg.2014.00036.
Roje, Z., Roje, Ž., Matić, D., Librenjak, D., Dokuzović, S. and Varvodić, J. 2011. Necrotizing fasciitis: Literature review of contemporary strategies for diagnosing and management with three case reports: Torso, abdominal wall, upper and lower limbs. World Journal of Emergency Surgery, 6(1), p.46. https://doi.org/10.1186/1749-7922-6-46.
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