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493 How to reconstruct an open abdominal wall after necrotizing fasciitis: surgical management in difficult cases
  1. Seda Sahin Aker1,
  2. Arda Özdemir2 and
  3. Fırat Ortaç1
  1. 1Ankara University Faculty of Medicine; Gynecologic Oncology
  2. 2Ankara University Faculty of Medicine; Plastic and Reconstructive Surgery


Introduction/Background Necrotizing fasciitis (NF) is a rare but very fatal infection involving and causing necrosis of the subcutaneous tissue and fascia. The incidence of NF is 0.4/100000. NF has a high mortality rate so it is needed an early diagnosis and proper treatment.There are several risk factors of NF. NF presents as painful, patchy discoloration of the skin without margins and a black necrotic plaque at the wound area. Ischemia and tissue necrosis can develop and local anaesthesia can occur because of the nerve damage.

Methodology A 59-year-old Turkish woman was admitted to hospital with a complaint of a postmenouposal bleeding. Patient underwent a probe curettage. The pathology report showed a grade 1 endometrioid type of endometrial carcinoma. A total abdominal hysterectomy and bilateral salpyngoophorectomy were performed. Final pathology report revealed that stage 1A endometrioid type of endometrium carsinom.

Results Third day after surgery patient had fever (38 °C), tachycardia (102 beat/min) swelling was spread to the upper abdominal wall skin, vaginal discharge.She underwent a hartman procedure, abscess debridman and end sigmoid colostomy procedure.Patient then underwent extensive surgical debridement after 48 hours and a vacuum sealing drainage dressing was placed to cover the open abdominal wall and a negative sucker was placed upon the anus for 5 days. The dressing was changed every 3 days. Cultures of the exudates from the wound grew Pseudomonas aeruginosa, Klebsiella pneumoniae. Antibiotic treatment was adjusted according to the sensitivity results. After 21 days of a negative pressure wound treatment, the abdominal wall defect was 15*15 cm diameter and the wound covered with a granulation tissue. Patient underwent a split thickness skin graft operation. In this video which we want to demonstrate how to reconstruct an open abdominal wall defect with a full thickness skin graft. After removing the granulation tissue, a good vascular supported tissue had seen and the necrotic wound had removed by a curette. The split thickness skin graft had taken from left leg’s superolateral healty skin with a measure of 10*25 cm diameter and 3 mm thickness. The skin is meshed to cover the large wound area. The graft covered the whole open abdominal wall and stitched up with 4,0 polipropilen sutures.

Conclusion Necrotizing fasciitis is an uncommon condition and has serious morbidity-mortality rate. Surgical debridement is the cornerstone of the treatment. NGWT combined with a STSG can help to heal wounds with NF.

Disclosures Picture 1:72 hours after STSG surgery

Picture 3: 3 months after STSG surgery

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