Management of massive soft tissue defects: The use of INTEGRA® artificial skin after necrotizing soft tissue infection of the chest

Abstract

Necrotizing soft tissue infection, such as necrotizing fasciitis, is a group of highly lethal infections especially when the chest is involved due to increased risk of pulmonary complications. Because aggressive radical debridement of all poorly perfused tissue is required, patients frequently suffer from massive skin defects, which often requires autograft skin grafting or myocutaneous flaps. However, options are limited in patients with limited autograft donor availability, or questionable underlying wound bed viability, such as in scleroderma. Here, we report the case of a 49 year old female with scleroderma who suffered from a necrotizing soft tissue infection of the chest extending to her right upper arm, underwent multiple radical debridements, and reconstruction of the consequent massive chest wall defect with INTEGRA® bilaminar dermal regeneration template. This approach required a thinner skin graft without flaps, allowed for the inherently diseased donor site to heal adequately, and avoided major infections and wound complications. This report highlights an important management option for this challenging disease.

Keywords: Chest necrotizing fasciitis; Integra.

Figure 1

A large skin and soft tissue defect involving her right axilla, anterior and lateral chest was noted after aggressive debridements for necrotizing soft tissue infection.

Figure 2

The skin and soft tissue defect after debridements extended to posterior of the chest as well.

Figure 3

INTEGRA® was placed on Day 25 after meshed 1:1. The wound was dressed with half-strength Sulfamylon solution applied dressing.

Figure 4

Good “neodermis” formation was confirmed on Day 46 when the outer layer of INTEGRA® was removed.

Figure 5

Split-thickness skin graft, set at 0.009 inches and meshed at 1^:1.5, was performed.