Negative Pressure Wound Therapy for Necrotizing Fasciitis and Compartment Syndrome of the Upper Extremity — a case report

Background: Necrotizing fasciitis (NF) is a lifethreateninginfection of the subcutaneous tissues that spreadsalong the underlying fascia. Despite the early and aggressivesurgical fasciotomy and necrectomy, its mortality rate is stillhigh. In NF the negative pressure wound therapy (NPWT)shows good effects on wound healing and on the primary closureof the concomitant extended tissue defects.Case report: A 32-year-old male patient was admitted witha four-day history of fever (39.1C), pain, swelling, erythemaof the right elbow and the upper arm. On admission, extensiveerythema and swelling were seen on the right forearm, arm,and the pectoral region with superficial skin bullae. Based onthe clinical symptoms and laboratory tests immediate surgerywas indicated. Extended fasciotomy and necrosectomy wereperformed on the full extremity and pectoral region. Negativepressure wound therapy was started immediately afterwardwith -120 mmHg concomitantly with antibiotic therapy.Results: After five cycles of NPWT the patient recoveredwithout needing any plastic surgical intervention. The functionaland aesthetic results were excellent.Conclusion: In the case of extended NF of the upper extremitythe aggressive surgery and NPWT are relatively safe andeffective.