Authors (including presenting author) :
Wong HC(1)
Affiliation :
(1)NTWC,Wound Team
Keyword 1: :
Wound Management
Keyword 2: :
Necrotizing fasciitis
Keyword 3: :
Wound bed preparation
Keyword 4: :
Hydro-mechanical irrigation
Introduction :
Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection characterized by extensive necrosis of affected area. Prompt surgical debridement and aggressive infection control are essential to reduce morbidity and mortality. However, ongoing management of the postoperative NF wound is challenging due to residual necrotic tissues, slough, bacterial burden as well as risk of recurrent infection. Multiple operations are commonly required in managing NF wound. Hydro-mechanical debridement is an innovative technology for wound bed preparation. With 8-15 psi, non-viable tissue and biofilm can be removed while preserving healthy tissue. The application of hydro-mechanical irrigation in postoperative NF wound can be beneficial to the patient outcomes and cost effectiveness.
Objectives :
To evaluate the clinical effectiveness of hydro-mechanical irrigation in managing a postoperative necrotizing fasciitis wound.
Methodology :
A patient diagnosed with NF underwent emergency operation. Wound nurse was consulted for postoperative wound management. Application of hydro-mechanical irrigation application to the NF is approved by Surgeon. The clotting profile and current medication of patient is reviewed to ensure no bleeding tendency. Pain team was consulted to ensure adequate pain control for the procedure. Hydro-mechanical irrigation and wound dressing is carried out in Daily interval for 5 consecutive days. The progress including wound size, tissues, color and consistence of exudate and other parameters were monitored throughout treatment.
Result & Outcome :
Results:
Application of the hydro-mechanical irrigation is effective in removal of debris, necrotic tissue and biofilm. Crusts over peri-wound skin can also be removed. Size and tunneling of the wound were gradually reduced while granulation tissue was increased. Amount and consistence of exudate was improved and odor was reduced. No further surgical debridement was required after the wound condition is reviewed by surgeon. The patient was satisfied with the treatment. Conclusion:
The application of hydro-mechanical irrigation is an innovative and efficient intervention in adjunct to conventional post-operative NF management. Wound bed preparation is achieved by removal of devitalized tissue, bioburden that compromise wound healing. Controlled hydro-mechanical irrigation preserving healthy tissue. Secondary surgical debridement is avoided. Patient was satisfied with the treatment. The case study underscores the potential role and benefits of hydro-mechanical irrigation application in managing complex, high-risk wounds such as necrotizing fasciitis. Further studies of application of hydro-mechanical irrigation in NF wounds and other wound types are suggested to establish standardized care protocols and evaluate long-term benefits.
