Early surgical intervention in necrotizing fasciitis: A report of case series
Main Article Content
Abstract
Necrotizing fasciitis (NF) is a rapidly progressive soft-tissue infection associated with high rates of mortality and limb loss, in which delayed surgical source control markedly increases the risk of septic shock and multiorgan failure. This study describes clinical characteristics and evaluates the role of early surgical source control combined with multidisciplinary management in improving survival and limb salvage in severe upper-extremity NF; we presented two cases treated at Bach Mai Hospital in 2025. Both patients underwent aggressive resuscitation, broad-spectrum antibiotics, continuous renal replacement therapy when indicated, and early surgical debridement performed concurrently with intensive care management. Following infection control, negative-pressure wound therapy (VAC) and staged reconstruction using split-thickness skin grafts and free flaps were performed. The first case involved type I NF after cobra envenomation complicated by polymicrobial infection and compartment syndrome, whereas the second case was type III NF caused by Vibrio vulnificus in an immunocompromised patient. In both cases, surgery was undertaken before complete hemodynamic stabilization. Clinical and hemodynamic conditions improved significantly after source control, and complex soft-tissue defects were successfully reconstructed using split-thickness skin grafts, free anterolateral thigh (ALT) flap, and chimeric ALT flap, allowing successful limb salvage in both patients. These findings highlight that early surgical source control remains the cornerstone of treatment for severe upper-extremity NF, while a multidisciplinary strategy combining intensive care, VAC therapy, and staged reconstruction may improve survival and facilitate limb preservation.
Article Details
Keywords
Necrotizing fasciitis, Necrotizing soft tissue infection, Surgical debridement, Negative-pressure wound therapy, Reconstructive surgery
References
2. Zhou L, Li H, Luo G, the CANF experts group representing the Chinese Burn Association, Editorial Board of the Chinese Journal of Burns and Wounds, Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Healthcare. Consensus on the diagnosis and treatment of adult necrotizing fasciitis (2025 edition). Burns Trauma. 2025;13:tkaf031. doi:10.1093/burnst/tkaf031
3. Martinov S, Ortiz S. Ten-year follow-up of a case of necrotizing fasciitis successfully treated with negative-pressure wound therapy, dermal regeneration template application, and split- thickness skin autograft. Acta Chir Belg. 2018;118(2):120-124. doi:10.1080/00015458.2017.1316618
4. Smeets L, Bous A, Heymans O. Necrotizing Fasciitis: Case Report and Review of Literature. Acta Chir Belg. 2007;107(1):29-36. doi:10.1080/00015458.2007.11680007
5. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections*: Crit Care Med. 2004;32(7):1535-1541. doi:10.1097/01.CCM.0000129486.35458.7D
6. La Padula S, Pensato R, Zaffiro A, et al. Necrotizing Fasciitis of the Upper Limb: Optimizing Management to Reduce Complications. J Clin Med. 2022;11(8):2182. doi:10.3390/jcm11082182
7. Wade SM, Henriques ME, Dingle ME, Tintle SM, Souza JM, D’Alleyrand JC. Synchronous Multifocal Necrotizing Fasciitis: A Case Report. JBJS Case Connect. 2020;10(1):e0152-e0152. doi:10.2106/JBJS.CC.19.00152
8. Ryssel H, Germann G, Kloeters O, Radu CA, Reichenberger M, Gazyakan E. Necrotizing fasciitis of the extremities: 34 cases at a single centre over the past 5 years. Arch Orthop Trauma Surg. 2010;130(12):1515-1522. doi:10.1007/s00402-010-1101-8
9. Goh T, Goh LG, Ang CH, Wong CH. Early diagnosis of necrotizing fasciitis. J Br Surg. 2014;101(1):e119-e125. doi:10.1002/bjs.9371
10. Cheng NC, Su YM, Kuo YS, Tai HC, Tang YB. Factors affecting the mortality of necrotizing fasciitis involving the upper extremities. Surg Today. 2008;38(12):1108-1113. doi:10.1007/s00595-008-3799-2
11. Mattison G, Leis AR, Gupta SC. Single-Specialty Management and Reconstruction of Necrotizing Fasciitis of the Upper Extremities: Clinical and Economic Benefits From a Case Series. Ann Plast Surg. 2014;72(Supplement 1):S18-S21. doi:10.1097/SAP.0000000000000173
12. Vayvada H, Demirdover C, Menderes A, Karaca C. Necrotizing fasciitis: Diagnosis Treatment and Review of the Literature. Turk J Trauma Emerg Surg. 2012;18(6):507-513. doi:10.5505/tjtes.2012.97523
13. Lee LH, Chalmers R, Muir T. Diagnosis, management and outcomes of necrotising soft tissue infection within a Plastic and Reconstructive Surgery Unit. Scott Med J. 2014;59(1):56-61. doi:10.1177/0036933013518155
14. Nawijn F, Verhiel SHWL, Lunn KN, Eberlin KR, Hietbrink F, Chen NC. Factors Associated with Mortality and Amputation Caused by Necrotizing Soft Tissue Infections of the Upper Extremity: A Retrospective Cohort Study. World J Surg. 2020;44(3):730-740. doi:10.1007/s00268-019-05256-9
15. Kim SW, Choi IK, Lee JH, Ahn ST, Rhie JW. Treatment of necrotising fasciitis using glycerol-preserved skin allografts for temporary wound coverage. J Wound Care. 2014;23(Sup2b):S20-S22. doi:10.12968/jowc.2014.23.Sup2b.S20
16. Collins J. Surgical intervention and customised dressings in an extremity wound caused by necrotising fasciitis: a case study. J Wound Care. 2019;28(Sup5):S21-S27. doi:10.12968/jowc.2019.28.Sup5.S21
17. Delavari S, Megas IF, Billner M, Reichert B, Breidung D. Necrotizing Fasciitis of the Hand: Management with Literature Review. Plast Reconstr Surg - Glob Open. 2024;12(7):e5981. doi:10.1097/GOX.0000000000005981