elastin and Fasciitis--Necrotizing

This case report describes a 55-year-old male patient with type II necrotizing fasciitis (NF) of the hand and forearm. The rapid progression of the tissue infection could be successfully stopped with radical surgical débridement and antibiotic therapy. For the reconstruction of the extensive loss of soft tissue a combination of split-thickness skin graft (STSG) and the synthetic dermal substitute MatriDerm® was used. In cases of NF, MatriDerm® and STSG provide a rapidly available and simple alternative to other reconstruction techniques.

Topics: Anti-Bacterial Agents; Collagen; Debridement; Elastin; Fasciitis, Necrotizing; Forearm; Hand; Humans; Male; Middle Aged; Skin Transplantation; Skin, Artificial; Soft Tissue Infections

Reconstruction of large abdominal wall defects is a challenging procedure, often contraindicated in critically ill patients, with high incidences of complications. We present a case of a patient with a large abdominal wall defect who had reconstruction with MatriDerm® (an engineered dermal template) and split thickness skin grafting (SSG) as an alternative to reconstruction with myo- or fascio-cutaneous flaps. Successful wound closure was achieved with a single technique, while providing a robust reconstruction and an interface between skin and underlying viscera, should further surgery be necessary.

Topics: Abdominal Wall; Abdominoplasty; Collagen; Debridement; Elastin; Fasciitis, Necrotizing; Female; Humans; Middle Aged; Negative-Pressure Wound Therapy; Skin Transplantation; Wound Healing

Necrotising fasciitis (NF) and Fournier's gangrene are still a source of high morbidity and mortality and a significant health-care resource consumption. These difficult cases are increasingly being referred to burn centres for specialised wound and critical care issues. Besides the total body surface area (TBSA) affected, location, co-morbidities, age and an immediate surgical treatment are important prognostic factors. The treatment of these patients is challenging and best performed by prompt diagnosis, immediate radical surgical debridement and aggressive critical care management. Referral to a major burn centre may help provide optimal surgical intervention, wound care and critical care management.As soon as the patient is stabilised, reconstruction of the injured areas becomes the main focus. As often seen, complete loss of dermal structures needs a depth adjusted--'multilayer'--reconstruction especially in critical areas. In modern reconstructive surgery, concepts of layer-specific reconstruction, including dermal substitution have to be considered. In this article, we present our recent experiences of five patients with NF who underwent dermal reconstruction with Matriderm® not only for better skin quality but also in some cases as an alternative to flap surgery when joint capsules or tendons were exposed.

Topics: Aged; Burn Units; Collagen; Debridement; Elastin; Fasciitis, Necrotizing; Female; Humans; Male; Middle Aged; Plastic Surgery Procedures; Skin, Artificial; Staphylococcal Skin Infections; Treatment Outcome