A method of surgical treatment of necrotizing fasciitis of the lower parts of the anterior abdominal wall
DOI:
https://doi.org/10.11603/2414-4533.2023.1.13803Keywords:
necrotizing soft tissue infection, necrotizing fasciitis, surgical treatment, abdominal wall, perforator vessels, sparing approach, skin-sparing debridement techniqueAbstract
The aim of the work – to develop a method of surgical treatment of the early stages of necrotizing fasciitis of the lower parts of the anterior abdominal wall.
Materials and Methods. A literature search in the PubMed databases was performed using the keywords "necrotizing soft tissue infections", "necrotizing fasciitis" (NF), "Fournier's gangrene", "perforators of the deep inferior epigastric artery" (DIEA). The clinical material consisted of 7 patients aged 41 to 79 years who were treated using the proposed method of surgical treatment.
Results and Discussion. A method of sparing surgical treatment of the early stages of NF of the lower parts of the abdominal wall with the preservation of the perforator vessels of the DIEA system has been developed. The study outlines the zone of potential intraoperative injury of perforators, in which it is advisable to perform a sparing separation with an emphasis on the mandatory preservation of perforator vessels. In all patients primary surgical interventions were performed with the surgical debridement of the main locus of the disease and the use of the proposed sparing method of surgical treatment abdominal wall. The preservation of the perforator vessels of the DIEA system in conditions of ischemia of soft tissues is important for perfusion and preventing the development of new necrosis in postoperative period. Most of the patients (6; 85.7 %) underwent one-time control revisions within 3–4 days, and no signs of the formation of new necrosis were noted. The further course of the disease in all patients was without complications. The need for closure of the main wound on the abdominal wall arose in 2 (28.6 %) patients and the wound defects were closed with secondary sutures.
Conclusions. The proposed sparing method of surgical treatment of necrotizing fasciitis of the lower parts of the anterior abdominal wall allows to minimize the probability of intraoperative damage to the perforators of the deep lower epigastric artery, to reduce the number of repeated surgical repairs and the need for plastic closure of wound defects.
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