Supportive Debridement Technique In The Treatment Of Necrotizing Fasciitis: Multiple Fasciotomy

Necrotizing fasciitis (NF) is an infectious disease with a possible fulminant course that it is characterized by necrosis of the skin, soft tissues, fascia or muscle. Treatment involves extensive debridement and antibiotherapy. Although, debridement may not always be possible due to limitations in the administration of general and/or block anesthesia in some patients based on such reasons as overall health, bleeding diathesis or medications being used by the patient. There is limited information or studies exploring possible options in such patients, although those that are available support the lifesaving advantages of early fasciotomies performed under local anesthesia. A 76-year-old male patient was admitted with generalized edema to the right forearm and arm, erythema, and a lesion with a bulla and purulent discharge. An NF diagnosis was confirmed with a positive finger test and emergency surgery was planned; however, general anesthesia could not be administered due to the impaired overall health status of the patient, who was using aspirin, preventing blockage. Accordingly, the abscess was drained through arm and forearm fasciotomies that were performed under local anesthesia, and samples were obtained for culture.In conclusion, NF can be fatal when left untreated, while successful results can be achieved with early diagnosis, sufficient debridement and treatment with appropriate antibiotics. That said, drainage of the abscess through multiple fasciotomies can improve the laboratory findings and support treatment in NF patients who cannot undergo rapid debridement or can not tolerate general anesthesia. A fasciotomy may be performed as a supportive treatment prior to debridement in such patients.