Use of Dehydrated Human Placental Mini-Membrane Allograft and Meshed Human Reticular Acellular Dermal Matrix for Limb Salvage of Advanced Necrotizing Fasciitis

Introduction: Necrotizing fasciitis is a life-threatening condition with rapid progression that is known to potentiate risk for limb amputation. Even with prompt and proper medical treatment via intravenous antibiotics management, fluid/electrolyte replenishment, and surgical debridement, amputation rates are as high as 22%, with mortality rates ranging from 6% to 76%. This is further complicated in patients with comorbidities (age, chronic systemic diseases, skin ulcers, or soft tissue infection). Although limb amputation is often seen as a life-saving procedure, the potential negative impact is increased patient mortality rates. The medical costs involved with the care of amputees (physical rehabilitation, prosthesis care, management of subsequent cardiovascular complications, recurrent ulcerations) can be significantly higher than the cost of limb salvage. Therefore, all attempts towards limb salvage should be made, if possible. We demonstrate a case report that examines the role of a single application of dehydrated placental mini-membrane with meshed human reticular acellular dermal matrix (HR-ADM) for limb salvage with advanced necrotizing fasciitis.Methods:65-year-old male had advanced necrotizing fasciitis to his right lower limb with poorly controlled type II diabetes mellitus (A1c 9.3%). Computed tomography demonstrated soft tissue emphysema tracking along the anterior aspect of the right lower limb to the knee. Initial treatment included emergent intravenous antibiotic administration, fluid/electrolyte replenishment, fasciotomy and extensive surgical debridement to excise all necrotic, infected tissue. Once the infection was cleared, subsequent treatment involved application of a multiplanar external fixator, application of dehydrated placental mini-membrane and meshed HR-ADM, followed by eventual split thickness skin grafting.Results:Limb salvage with full wound closure was achieved approximately 13 weeks after single application of dehydrated placental mini-membrane and meshed HR-ADM. No complications, functional deficits, or new ulcerations were noted.Discussion: Limb amputation can be a life-saving procedure to treat necrotizing fasciitis. However, the subsequent quality of life and medical costs involved with the care of amputees carry significant negative implications. Therefore, all attempts towards limb salvage should be made. The use of dehydrated placental mini-membrane and meshed HR-ADM may be an effective modality to assist in limb salvage of complex necrotizing infections that minimize the risk of amputation.References: