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

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-02-17T10:00:27+05:30 | Updated On 17 Feb 2023 2:22 PM IST

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.

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751