Use of vacuum-assisted wound closure to manage limb wounds in patients suffering from acute necrotizing fasciitis.

摘要

BACKGROUND: An effective regimen to treat patients suffering from acute necrotizing fasciitis requires surgical removal of devitalized tissues, systemic administration of broad antimicrobials and ameliorating underlying systemic disease processes. The task of managing wounds consequential to surgical debridement, on the other hand, can be difficult. We had the opportunity of using a vacuum-assisted wound closure (VAC) technique in 12 patients with non-healing wounds in either the upper or the lower limb because of acute necrotizing fasciitis. The usefulness of the device was assessed by comparing with the conventional approach of wet dressing technique of wound care. METHODS: A vacuum-assisted wound closing device was used in 12 patients with open wounds. For comparison, the conventional technique of wound care, i.e., the wet dressing technique, was used in 12 patients. The change in wound size, amount of drainage and the mortality rate were recorded in each group. RESULTS: The extent of wound size reduction noted in the VAC group was 47%, while in the conventional wet-to-dry dressing (CWD) group, it was 41%. The amount of drainage reduction noted was 49% in the VAC group and 39% in the CWD group. The cost of supplies for the CWD group was about one-seventh that of the VAC group. On the other hand, time required for the care was decreased by 3.7-fold with the use of the VAC technique. CONCLUSION: The VAC technique of wound closure was found to be effective in managing non-healing limb wounds consequential to surgical treatment for patients suffering from acute necrotizing fasciitis. Although the cost of the VAC device was high, morbidity was much lower when compared to the CWD technique.