chondroitin-sulfates and Fasciitis--Necrotizing

Necrotizing fasciitis (NF) and purpura fulminans (PF) are conditions with extensive septic skin necroses that are associated with significant morbidity and mortality. NF is caused by fulminant bacterial spread on the superficial muscle fascia, Group A streptococcus being the main microorganism responsible for it. The major challenge NF poses is timely recognition. Although crucial for patient survival, early diagnosis is difficult because paucity of specific early findings does not allow setting NF apart from other, less severe, differential diagnoses. Surgical therapy consists of early and aggressive debridement of all affected tissue, even if large disfiguring wounds are left back. The responsible microorganism for PF in children is predominantly Neisseira meningitidis. Endotoxin triggered misbalance of anticoagulant and procoagulant activities of endothelial cells leads to disseminated intravascular coagulation (DIC) followed by microvascular thrombosis and bleeding, resulting in hemorrhagic skin infarction and limb ischemia. Although survival in PF is not dependent on surgery, and surgery plays not a key role in the early phase of the disease, early surgical consult to assess if limb perfusion can be improved to achieve limb salvage is still absolutely necessary. Debridement should be postponed until clear demarcation has established. Large defects after NF and PF can be successfully reconstructed with vacuum-assisted fixation of Integra (Integra LifeSciences Corporation, Plainsboro, New Jersey, United States) artificial skin before split-thickness skin grafting. This provides good functional and cosmetic results as well as good stump coverage in case of amputation in PF.

Topics: Amputation, Surgical; Child; Chondroitin Sulfates; Collagen; Debridement; Fasciitis, Necrotizing; Humans; Limb Salvage; Meningococcal Infections; Negative-Pressure Wound Therapy; Neisseria meningitidis; Plastic Surgery Procedures; Purpura Fulminans; Skin Transplantation; Skin, Artificial; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Necrotizing fasciitis (NF) is a rapid infectious process involving the fascia and subcutaneous tissue. Current standards of care rely on surgical debridement, resulting in large defects, with limited reconstructive options. Wound management has evolved over the last decade, including use of bilayer wound matrices (BWM). The authors sought to assess the use of collagen-GAG bilayer wound matrices on STSG take for NF wounds.. A qualitative clinical evaluation (2016-2018) was performed to analyze the efficacy of BWM to aide in STSG take. Primary outcomes were 180-day bilayer matrix success, defined by progressing to split-thickness skin graft (STSG) and STSG take, determined by clinical evaluation. Wounds without a diagnosis of NF or reconstruction with BWM were excluded.. Ten patients with 11 NF wounds were identified. Average BMI was 32 kg/m. Complex defects caused by soft tissue necrotizing infections remain a reconstructive challenge. We highlight the benefit of a BWM as a treatment modality for reconstruction by priming the wound bed for a definitive STSG.

Topics: Chondroitin Sulfates; Collagen; Fasciitis, Necrotizing; Follow-Up Studies; Humans; Middle Aged; Plastic Surgery Procedures; Retrospective Studies; Skin Transplantation; Treatment Outcome

Topics: Aged; Burns; Chondroitin Sulfates; Collagen; Debridement; Fasciitis, Necrotizing; Female; Humans; Hypnotics and Sedatives; Midazolam; Skin, Artificial; Wound Healing

Topics: Adult; Arm; Chondroitin Sulfates; Collagen; Fasciitis, Necrotizing; Female; Heroin Dependence; Humans; Plastic Surgery Procedures

Necrotising fasciitis of the external genitalia following routine circumcision is uncommon. We describe reconstruction of the scrotum with local perforator flaps and a dermal regeneration template (Integra) to cover the penile shaft after debridement. Lotus petal flaps were originally designed to cover vulvo-vaginal defects, but in this instance integrated well with the remaining scrotal sac to produce a good volume neoscrotum for testicular cover. Integra creates an acceptable neodermis usually to cover areas of debrided full thickness burns. In this case, Integra adequately replaced the mobile dermal layer over Bucks fascia over the penis to create a pliable and cosmetically acceptable result with erectile capability.

Topics: Abdominal Wall; Adult; Chondroitin Sulfates; Circumcision, Male; Collagen; Fasciitis, Necrotizing; Humans; Male; Penile Diseases; Penis; Plastic Surgery Procedures; Scrotum; Streptococcal Infections; Surgical Flaps; Treatment Outcome

Topics: Cellulitis; Chondroitin Sulfates; Collagen; Debridement; Fasciitis, Necrotizing; Humans; Male; Middle Aged; Skin, Artificial; Treatment Outcome