Vacuum-assisted closure significantly decreases mortality compared to conventional dressing in necrotizing fasciitis

Vacuum-assisted closure could significantly decrease the death rate compared to conventional dressing in necrotizing fasciitis: study.

Necrotizing fasciitis (NF) is a rapid and severe soft tissue infection that targets subcutaneous fat tissue, muscle, and fascia. NF has different names, including streptococcal gangrene, gas gangrene, suppurative fasciitis, Meleney’s gangrene, necrotizing erysipelas, and Fournier’s gangrene.

Surgically successful and timely diagnosis is essential in managing this rare and rapidly progressing disease. A high mortality rate of 12–20% has been reported, especially without early surgical intervention. After wound debridement and systemic antibiotics according to bacterial culture, a large open wound usually remains. The wound is traditionally managed with the conventional dry or wet gauze technique before covering it with a skin graft, flap, or musculocutaneous flap.

VAC by pulling wound edges together to narrow the wound size, promoting granulation tissue formation on the wound bed for skin-grafting, promoting microcirculation, decreasing edema, and removing infectious tissues.

Zhang et al conducted a study to compare the clinical outcomes of vacuum-assisted closure (VAC) versus conventional dressing on necrotizing fasciitis. The article has been published in “Journal of Orthopaedic Surgery and Research.”

The authors systematically searched Embase, Cochrane, and PubMed for clinical trials (published between January 1, 1995 and September 30, 2021), which compared VAC with conventional dressing for necrotizing fasciitis. The mortality rate of necrotizing fasciitis was the primary outcome of this study. The number of debridements, the total length of hospital stay, and the complication rate were secondary outcomes. A random effects model assessed all pooled data.

Key findings of the study were:

• A total of 230 identified studies and seven controlled clinical trials met the inclusion criteria and were included in this analysis (n=249 participants).

• Compared to the conventional dressing, patients treated with VAC had a significantly lower mortality rate [OR=0.27, 95% CI (0.09, 0.87)] (P=0.03).

• Total length of hospital stays [MD=8.46, 95% CI (− 0.53, 17.45)] (P=0.07), number of debridements [MD=0.86, 95% CI (− 0.58, 2.30)] (P=0.24), and complication rate [OR=0.64, 95% CI (0.07, 5.94)] (P=0.69) were not significant.

The authors concluded that – “VAC could significantly decrease the death rate compared to conventional dressing. No significant impacts were found on the number of debridements, the total length of hospital stay, and the complication rate in this study.”

Level of evidence Level-III.

Further reading:

Vacuum-assisted closure versus conventional dressing in necrotizing fasciitis: a systematic review and meta-analysis. Rongli Zhang, Yahui Zhang et al Journal of Orthopaedic Surgery and Research (2023) 18:85 https://doi.org/10.1186/s13018-023-03561-7