Successful salvage and reconstruction of a finger threatened by Vibrio vulnificus necrotising fasciitis using fenestrated-type artificial dermis and three steps of topical negative pressure wound therapy

Abstract

Vibrio vulnificus can cause severe skin and soft tissue infection (SSTI). The pathogen is an opportunistic marine bacterium that is likely to infect patients with chronic liver disease, patients in an immunocompromised state, and those in end-stage renal disease. V. vulnificus gains entry through soft tissues by direct penetration of a wound by infected marine organisms, such as raw oysters, shellfish and other seafood, or by exposing a wound to contaminated water. Despite its ease of entry, V. vulnificus necrotising fasciitis with compartment syndrome has rarely been described. We report a case of an elderly patient with end-stage renal disease undergoing haemodialysis, who developed necrotising fasciitis following infection by V. vulnificus through a puncture injury while cleaning fish. A successful salvage and reconstruction surgery was performed using fenestrated-type artificial dermis followed by negative pressure wound therapy. This case presents a reasonable treatment option for threatening V. vulnificus necrotising fasciitis with compartment syndrome.

Keywords: Artificial dermis; Compartment syndrome; NPWT; Necrotising fasciitis; Vibrio vulnificus.

Figure 1

(A) A bluish discolouration with some haemorrhagic bullae was noted over the swollen left hand and the middle finger, in particular. Furthermore, an arteriovenous fistula was noted (arrow). (B) The emergent surgical debridement and fasciotomy for suspected necrotising fasciitis complicated by compartment syndrome was performed.

Figure 2

(A) Four days after admission, extensive necrotic tissue with tendon exposure in both the dorsal and volar sides of the finger was noted. (B) Twenty‐one days after admission (10 days after NPWT applied), the infectious wound was cleared and did not exhibit necrosis. The swollen hand subsided with skin turgor emerging; however, the tendon was still exposed over the dorsal hand and middle finger (arrow).

Figure 3

(A) Twenty‐one days after admission (10 days after NPWT applied over the wound), the fenestrated‐type artificial dermis (arrow) implanted at the dorsal and volar middle finger supplemented with NPWT was performed to cover the exposed tendon. (B) Thirty‐five days after admission (14 days after the artificial dermis bolstered with NPWT), the artificial dermis was well vascularised.

Figure 4

(A) Autologous split‐thickness skin graft (STSG) supplemented with NPWT was applied to cover the well‐grown artificial dermis that had grown to a thickness of 10/1000 inch. (B) Forty days after admission (5 days after STSG supplemented with NPWT), autologous STSG was well‐grown in imbibition status.

Figure 5

The algorithm of hospitalisation, including the three steps of topical negative pressure wound therapy (NPWT) application.