Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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A Novel Surgical Approach to the Treatment of Necrotizing Soft Tissue Infections: Thinking Reconstruction at Diagnosis
Laura K. Tom, MD, Thomas Wright, BS, Dara Horn, BS, Eileen Bulger, MD, Tam Pham, MD, Kari A. Keys, MD.
University of Washington, Seattle, WA, USA.

PURPOSE:
The infrequent nature and rapid progression necrotizing soft-tissue infections (NSTI) make prompt and appropriately aggressive intervention vital to survival. Literature supports that early and complete debridement is essential for the survival of patients with an NSTI; however, the extensive debridements leave survivors from NSTI with significant soft tissue defects. It is possible that the extensive debridement of tissues should be focused on those undergoing necrosis, leaving viable skin in place despite involvement of deeper tissues. The purpose of this study is to present a small case series of skin-sparing debridements of NSTI and their subsequent reconstructions.
METHODS:
In conjunction with the Department of Surgery, a consensus agreement was made to trial skin sparing debridement in all NSTI patients, leaving ultimate clinical choices up to each surgeon. Landmarks and diagrams for each body region (examples below) were designed to allow for full access to underlying diseased tissue while optimizing future reconstruction through basic principles: maintaining unaffected skin, preserving skin perforators, and joint and vital structure coverage.

RESULTS:
We present eight cases of skin sparing debridement and subsequent reconstruction including thigh, axilla, fourniers, buttock, and abdomen. This approach has allowed for wounds amenable to delayed primary closure or healing by secondary intention, smaller overall skin grafts and avoidance of flaps. Photos: right thigh wound after NSTI debridement and staged delayed primary closure.


CONCLUSION:
The reconstructive outcomes of these skin sparing cases surpass that of the traditional debridement and extensive grafting traditionally performed. Increasing survivorship demands that the focus turn from mortality to functional quality of survivors. Our current goal is to demonstrate safety and efficacy of this approach and delineate inclusion and exclusion criteria. We will also be investigating the impact this has on hospital utilization, cost efficiency and patient quality of life outcomes.


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