Lipatov KV, Asatryan A, Melkonyan G, Kazantcev AD, Solov’eva EI, Krivikhin DV, Gorbacheva IV, Cherkasov UE. Effectiveness of negative pressure wound therapy in complex surgical treatment of necrotizing fasciitis of the upper limb. World J Orthop 2024; 15(11): 1015-1022 [PMID: 39600855 DOI: 10.5312/wjo.v15.i11.1015]
Corresponding Author of This Article
Konstantin V Lipatov, DSc, MD, Full Professor, Surgeon, Department of General Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Rossolimo Street 11-2, Moscow 119021, Russia. lipatov_k_v@staff.sechenov.ru
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Nov 18, 2024; 15(11): 1015-1022 Published online Nov 18, 2024. doi: 10.5312/wjo.v15.i11.1015
Effectiveness of negative pressure wound therapy in complex surgical treatment of necrotizing fasciitis of the upper limb
Konstantin V Lipatov, Arthur Asatryan, George Melkonyan, Aleksandr D Kazantcev, Ekaterina I Solov’eva, Denis V Krivikhin, Irina V Gorbacheva, Urii E Cherkasov
Konstantin V Lipatov, Aleksandr D Kazantcev, Department of General Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia
Arthur Asatryan, Denis V Krivikhin, Department of General Surgery, Wound and Wound Infection Surgery, State Budgetary Institution “City Clinical Hospital named after S.S. Yudin of Moscow Healthcare Department”, Moscow 115446, Russia
George Melkonyan, Department of General Surgery, Physician of The Hospital for War Veterans No 3, Moscow 129336, Russia
Ekaterina I Solov’eva, Irina V Gorbacheva, Urii E Cherkasov, Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia
Author contributions: Lipatov KV performed conceptualization, and manuscript writing, review, and editing; Asatryan A and Melkonyan G performed methodology and writing of the original draft; Kazantcev AD performed visualization, and manuscript writing, review, and editing; Solov’eva EI and Gorbacheva IV performed investigation and writing of the original draft; Krivikhin DV and Cherkasov UE performed formal analysis and supervision.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at lipatov_k_v@staff.sechenov.ru.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Konstantin V Lipatov, DSc, MD, Full Professor, Surgeon, Department of General Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Rossolimo Street 11-2, Moscow 119021, Russia. lipatov_k_v@staff.sechenov.ru
Received: June 11, 2024 Revised: September 22, 2024 Accepted: October 10, 2024 Published online: November 18, 2024 Processing time: 156 Days and 12.7 Hours
Abstract
BACKGROUND
Necrotizing fasciitis (NF) of the upper extremities is a severe surgical pathology, and the incidence of this disease has been steadily increasing in recent decades. Surgical treatment is accompanied by the formation of extensive wounds, which can be treated with significant difficulties. In recent years, negative pressure wound therapy (NPWT) has proven to be highly effective. It is also promising for the treatment of NF.
AIM
To explore the effectiveness of NPWT in the treatment of NF of the upper extremities.
METHODS
The results of the treatment of 36 patients with NF of the upper extremities in two groups (NPWT group and control group; 2022−2023) were retrospectively analyzed. In the NPWT group, the NPWT method (120 mmHg; constant mode) was used after surgical treatment. The number of vacuum-assisted dressings in patients ranged from 1 to 3, depending on the dynamics of the wound process. The duration of fixation of one bandage was up to 2−3 d. In the control group, conventional methods of local wound treatment were used. The following indicators were analyzed: The treatment delay, the prevalence of inflammation, the microbial landscape, the number of debridements, the duration of wound preparation for surgical closure, and the nature of skin plastic surgery.
RESULTS
Most patients experienced a significant treatment delay [4 d, interquartile range (IQR): 2–7 d], which led to the spread of the pathological process to the forearm and shoulder. The most common pathogens were Staphylococcus aureus (14; 38.9%) and Streptococcus pyogenes (22; 61.1%). The average number of debridements per patient was 5 (IQR: 3–7), with no difference between groups. The average time to prepare wounds for surgical closure was 11 ± 4 d in the NPWT group and 29 ± 10 d (P = 0.00001) in the control group. In the NPWT group, the wounds were more often closed with local tissues (15; 83.3%), and in the control group, split-thickness skin grafts were more often used (4; 50%).
CONCLUSION
The predominant isolation of Staphylococcus aureus and/or Streptococcus pyogenes from the lesions allowed us to classify these patients as NF type II. Multiple debridement procedures have become a feature of this disease treatment. The use of NPWT has significantly reduced the time required to prepare wounds for surgical closure. Early closure of wounds allows for more frequent use of local tissue repair, which ensures better results. NPWT is a highly effective way to prepare wounds for early surgical closure in patients with upper extremity NF.
Core Tip: Negative pressure wound therapy, performed after full surgical debridement for necrotizing fasciitis of the upper extremities, significantly reduces the duration of postnecrectomy wound preparation for surgical closure, thereby improving patient treatment outcomes.
