Necrotizing Fasciitis Debridement

The procedure is an emergency intervention, often requiring multiple stages:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Clinical signs: Severe pain, crepitus (gas under skin), systemic toxicity (fever, tachycardia, hypotension).
     • Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score: Score ≥6 (based on WBC, hemoglobin, sodium, glucose, creatinine, CRP) suggests NF.
     • Imaging: CT or MRI shows gas in tissues, fascial thickening, or fluid collections; often skipped in clear cases due to urgency.
     • Blood tests: Elevated WBC, lactate, and signs of organ dysfunction (e.g., creatinine).
   • Broad-spectrum IV antibiotics (e.g., piperacillin-tazobactam, vancomycin, clindamycin) are started immediately.
   • IV fluids and vasopressors stabilize the patient if septic shock is present.
2. Surgical Techniques:
   
   • Initial Debridement:
     
     • Performed under general anesthesia, lasting 1–3 hours, depending on the extent of infection.
     • Common sites: Lower limbs (most frequent), perineum (Fournier’s gangrene), abdomen, or trunk.
     • Wide incisions are made over the affected area, extending beyond visible infection into healthy tissue.
     • All necrotic tissue (skin, subcutaneous fat, fascia, and sometimes muscle) is excised until healthy, bleeding tissue is reached.
     • The “finger test” may be used: A probe or finger checks for easy separation of fascia from muscle, indicating necrosis.
     • Tissue samples are sent for culture to guide antibiotic therapy.
   • Wound Management:
     
     • The wound is left open to prevent pressure buildup and allow drainage.
     • Sterile dressings or a vacuum-assisted closure (VAC) device are applied to manage the wound and promote healing.
   • Repeat Debridements:
     
     • Often required every 24–48 hours (1–3 additional surgeries) until no further necrosis is present.
   • Supportive Measures:
     
     • Hyperbaric oxygen therapy (if available) may reduce tissue hypoxia, though evidence is limited.
     • Fournier’s gangrene (perineal NF) may require a diverting colostomy to prevent fecal contamination.
   • Wound Closure:
     
     • Once infection is controlled (5–14 days), delayed closure, skin grafting, or flap reconstruction is performed.
3. After Surgery:
   
   • ICU monitoring for 3–7 days manages sepsis, organ failure, and fluid resuscitation.
   • Hospital stay: 2–6 weeks, depending on infection control and wound healing.
   • Antibiotics are continued for 2–4 weeks, adjusted based on culture results.
   • Nutrition support (parenteral or enteral) aids recovery in critically ill patients.