Free tissue transfer for necrotizing fasciitis reconstruction: A case series

Abstract

Background: Necrotizing fasciitis (NF) is a life-threatening infection requiring extensive debridement that may necessitate amputation. Free tissue transfer (FTT) is an option for reconstruction in difficult cases. Currently, only case reports have described FTT in the setting of NF, and comprehensive evidence on flap outcomes is lacking. The present study characterizes outcomes in patients with FTT following NF.

Methods: All patients admitted with NF between January 1, 2005 and December 31, 2011 to our level 1 burns/trauma referral center were retrospectively reviewed.

Results: No significant difference was found in patient demographics between FTT (n=12) and no FTT (n=212). Both groups had the same number of operations, same length of ICU stay, and length of hospitalization. The flaps used were 10 anterolateral thigh, 1 latissimus dorsi and 1 radial forearm. Recipient sites included: upper extremities (6), lower extremities (4), head/neck (1), and genitalia (1). No flap failures and no take-back operations were required. Upper extremities comprised 58.3% of FTT patients compared to 18.9% (p=0.004) in non-FTT patients. Flap operations occurred a mean of 11.6days post-admission with 1.1 operations prior to FTT. Mean FTT size was 213cm². Flap complications included seroma (n=1), hematoma (n=1). Donor site complications included hematoma (n=1), exposed tendon (n=1) and necrosis (n=1).

Conclusions: This study demonstrates that FTT provides a promising reconstructive option in the setting of NF without adversely affecting patient outcome.

Keywords: Flap; Free tissue transfer; Necrotizing fasciitis; Reconstruction.