Negative Pressure Wound Therapy with Instillation as an Early Intervention for Extensive Wounds from Necrotizing Fasciitis

Problem: 50-year-old woman hospitalized with a diagnosis of necrotizing fasciitis from a labial abscess. Several trips to the operating room for debridement of necrotic tissue, causing complex, extensive full-thickness wounds on abdomen, groins, and mons pubis. Wounds frequently contaminated with stool, despite use of fecal diversion system. Contamination of stool was causing the need for daily surgical intervention for irrigation and additional debridement.

Solution: Certified Wound Ostomy Continence Nurse (CWOCN) was consulted by surgery team for wound care recommendations to avoid daily OR procedures. CWOCN saw patient in the OR after debridement, placed a NPWTI system using normal saline. NPWTI dressing changed twice weekly in the OR for two weeks. With the use of NPWTI, the patient avoided daily OR dressing changes and stated better pain control.

Discovery: With the use of NPWTI as an early intervention, granulation tissue formation assessed on first dressing change. Healing occurred rapidly, thus allowing plastic surgery to close the complex wound in 29 days from admission. Early closure of complex, extensive wounds significantly decreased patient’s length of stay in the hospital and additional hospital admissions, from the CWOCN’s past experience with this type of wound from necrotizing fasciitis.

Nursing Implications: The CWOCN found that performing NPWTI dressing changes in the OR allowed for many advantages: controlled environment, optimal pain control, better positioning, and quicker wound healing than with traditional wound therapy. Performing the dressing change in the OR by the CWOCN made it more conducive for NPWTI to be used early in the patient’s admission. The positive outcome of wound healing, using early intervention of NPWTI, led to establishing this as a hospital standard of care with wounds from necrotizing fasciitis.