Successful Management of Necrotizing Infection Extending to Bone: A Case Series

Necrotizing Fasciitis (NF) is a devastating infection requiring prompt recognition and treatment. Debridement of associated necrotic tissue may result in exposure of bone. With limb involvement, the standard of care remains amputation for disease that threatens the life of the patient. However, limb salvage remains a controversial treatment option when bone is exposed. We describe a successful case series of the management of severe necrotizing infection resulting in exposed bone.

We performed a retrospective review of nine patients suffering from NF at Rush University Medical Center between 2017 and 2019. Patients were included if: a) clinical findings of NF were confirmed by pathology at the time of debridement, and b) surgical debridement resulted in exposed bone. In each case, surgical debridement to bone was performed to clear the necrotizing infection.

Nine patients were included; 3(33%) females, 6 (67%) males. The mean age was 42 (22-56), mean BMI was 30 kg/m2 (18 -47.0 kg/m2), and most were diabetic (6 of 9; 67%). Anatomic regions of NF included: upper extremity in 1 patient (11%), lower extremity in 6 patients (67%), and trunk/pelvic in 2 patient (22%). All patients were treated with prompt surgical debridement and limb salvage therapy when indicated with success; 1 of 9 (11%) patients expired from unrelated illness. One patient (11%) required amputation of the affected limb at approximately 6 months follow-up for limb salvage failure.

NF can be a severe infection that threatens the life of the patient. There is controversy regarding the application of salvage therapy in NF, especially when debridement down to the bone is required to clear the infection. We present 9 cases of severe NF; most were managed successfully with multi-disciplinary salvage therapy, including aggressive serial debridement to exposed bone and subsequent reconstruction.

Trademarked Items (if applicable):

References (if applicable):