Operations for Necrotizing Fasciitis of Abdominal Wall and Infected Abdominal Wound Dehiscence
Necrotizing fasciitis that involves the superficial fascia of the abdominal wall produces necrosis primarily of the subcutaneous fat. The appearance of the overlying skin may be deceptively normal. A small area of apparent skin necrosis may be accompanied by an extensive (5–10 cm) area of necrotic subcutaneous fat. The underlying musculoaponeurotic layer often remains intact. The bacterial organisms are generally beta-hemolytic streptococci, staphylococci, or Gram-negative rods combined with anaerobes. Therapy requires the prompt excision of all of the subcutaneous fat and overlying skin until the surgeon encounters subcutaneous fat and skin that bleeds upon being incised. Take multiple samples of tissue and/or pus for culture and immediate Gram’s stain studies. Aitken, Mackett, and Smith advise serial studies of muscle compartment pressures (wick catheter, Sorensen Research Co., Sandy, Ohio) in patients with necrotizing diseases of the extremities. Elevated compartmental pressure recordings constitute an indication for fasciotomy, biopsy, and debridement.
KeywordsNecrotizing Fasciitis Marlex Mesh Prolene Mesh Gauze Packing Retention Suture
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