Necrotizing fasciitis in a pediatric patient: Successful management in the inguinal area - A case report

Introduction

Necrotizing fasciitis (NF) is a rare life-threatening medical and surgical emergency. We present a case of a pediatric patient diagnosed with necrotizing fasciitis in the inguinal area which required debridement and post-operative management of the residual wound using a combination of wound closure techniques.

Case presentation

A 10-months-old girl with a history of Food-protein induced enterocolitis syndrome (FPIES) presented with septic shock and ulcerative lesions of the inguinal area. She was admitted to the Intensive Care Unit (ICU) of our hospital, antibiotic treatment was administered and a diverting colostomy was performed. Serial surgical debridement of the affected tissues resulted in an extensive tissue deficit. Management of the residual skin and soft tissues deficit included application of Negative Pressure Wound Therapy (NPWT) with Vacuum-Assisted Closure (VAC) and was followed by Oasis® extracellular matrix (ECM) graft placement. After 65 days of hospitalization, the wound surface was completely epithelialized.

Discussion

A challenging aspect of NF management is the closure of the residual skin and soft tissue deficit after surgical debridement. Considering the patient's characteristics, a less invasive reconstructive technique was sought. Application of NPWT followed by ECM graft placement are two effective options that can be combined in different stages of wound healing.

Conclusions

The management of the residual wound after surgical debridement of the affected tissue in NF requires a patient – specific approach and constant reevaluation of the management plan. NPWT and ECM graft placement can significantly contribute to wound closure and epithelization of the residual deficit in children.