Systematic Review on Use of Negative Pressure Wound Therapyin The Treatment of Necrotizing Fasciitis

J Korean Wound Management Soc > Volume 10(2); 2014 > Article

Review

Journal of the Korean Wound Management Society 2014;10(2): 80-88.

괴사성 근막염 치료에 있어 음압치료에 대한 체계적인 검토

우경제ㆍ문구현

성균관대학교 의과대학 삼성서울병원 성형외과학교실

Systematic Review on Use of Negative Pressure Wound Therapyin The Treatment of Necrotizing Fasciitis

Kyong-Je Woo, Goo-Hyun Mun

Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Published online: 30 November 2014.

ABSTRACT

Necrotizing fasciitis (NF) is a rapid progressive infection of soft tissue including subcutaneous tissue, fascia and skin.It often causes complicated, large open wound after aggressive debridement. The aim of this study is to performa systematic review on use of negative pressure wound therapy (NPWT) in the treatment of NF. A systematic literaturereview in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.A search of MEDLINE and Cochrane Collaboration was performed using 4 search items. All articles were screenedfor eligibility for the study design. Of the articles met this criteria, data on patient demographics, microbial pathogens,sites affected, duration of NPWT, treatment and outcome were extracted. A total 45 articles among total 129 met ourinclusion criteria. 42 articles were included for quantitative analysis, total 106 cases were analyzed. Mortality wasreported in 3 cases (3%) and 1 case of silver toxicity after applying NPWT with silver contained sponges were reported.Application of NPWT following aggressive debridement enabled accelerated wound healing, salvage of vital organs,and preservation of the skin. Infants and young children (0∼14 months) tend to gain complete healing without surgicalreconstruction compared to adults (P=0.03, two tailed). NF in perineum also has higher rate of complete healing withoutsurgery than that of other region (P=0.014, two tailed). Having 3 or more baseline comorbidities has correlation withmortality (P=0.014, two tailed). NF was treated successfully using NPWT as an adjuvant therapy with low morbidityand mortality. NF of infants and young child, perineal NF showed higher rate of secondary healing by applying NPWT.Having 3 or more baseline comorbidities has correlation with mortality. (J Korean Wound Management Soc2014;10:80-88)

Key Words: Necrotizing fasciitis, Vacuum-Assisted closure, Negative-Pressure wound therapy, Debridement, Secondary healing