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Debridement in the treatment of necrotising fasciitis

Apr 3, 2024 | Awareness, Treatment | 0 comments

Necrotising fasciitis is a rare and life-threatening condition normally caused by a bacterial infection affecting the skin’s deeper layers, including the fascia and muscles. It spreads rapidly and can lead to tissue death and organ failure if left untreated. In this post, we will explore the importance of debridement in the treatment of necrotising fasciitis and its role in saving lives.

We’ll also be including some quotes from survivors and their families relating to debridement, so you can get a real understanding of what it means from their perspective – Some readers may find these quotes distressing.

What is Debridement?

Debridement is an essential component of the treatment plan for necrotising fasciitis. As the infection progresses, bacterium release toxins that destroy healthy tissue, leading to a build-up of dead and infected material. This ‘necrotic’ (dead) tissue hampers the effectiveness of antibiotics as the blood supply to the tissue is negatively affected.

During debridement, the surgeon, often a plastic surgeon, carefully removes all visibly dead or damaged tissue, including the fascia and muscles if necessary. This prevents the further spread of the infection and allows antibiotics to reach other areas more effectively.

Types of Debridement

There are different types of debridement techniques used in the treatment of necrotising fasciitis, depending on the severity of the infection and the patient’s condition. Surgical debridement is the most common and effective method, involving the use of scalpels, scissors, or forceps to remove necrotic tissue. This procedure is performed in the operating room under general anaesthesia.

Another type of debridement that may be necessary in the treatment of necrotising fasciitis is amputation, which we will be exploring in our next article.

Over the next 10 days I had many more trips to theatre for more debridement of the infected tissue on my leg…I was brought round, confused and unable to comprehend what I was told. My leg was so badly affected and in such a bad way that the doctors needed me to make the decision about what to do about it’s future. It was basically just bone between my knee and ankle.

Debbie’s story

Repeated debridement of necrotising fasciitis cases

In some cases, repeated debridement procedures may be necessary to ensure complete removal of infected tissue. This iterative approach is crucial as it helps to prevent the infection from spreading and significantly improves the chances of successful treatment.

I was placed into an induced coma and I had up to 22 operations where they would take me down to theatre, cut away any dead flesh and skin, and then take me back up to the unit to assess how it was all going. They fitted me with a urinary catheter and a bum bag and as time progressed they fitted me with a vacuum pump which used to suck all of the bad stuff out of my wound in between operations and cleaning.

Russell’s story

Debridement coupled with treatments for necrotising fasciitis

For the effective treatment of necrotising fasciitis debridement is utilised in combination with other treatments such as intravenous antibiotics, intravenous fluids, full blood transfusions, kidney dialysis, VAC assisted closure of wounds, clean dressing changes and the patient may be kept in a sedated state in intensive care.

Skin grafts, performed by a plastic surgeon, are often required following debridement in order to reconstruct the area where the tissue was removed from.

“I was told they had to remove skin and tissue from my stomach the size of 22cm by 15cm because the infection spreads so quickly and kills the tissue and the only way to stop it is to cut it out. Because further operations were needed, the wound was left open with a vacuum seal on it to prevent further infection…Three days after the first op I was then opened up again so they could remove more dead tissue that the infection had killed. Four days after this I was put under again for one final check and for the surgeons to close me up.

Emma’s story

The Importance of Early Intervention

Early intervention is key in the successful treatment of necrotising fasciitis. Recognising the signs and symptoms of the infection and seeking immediate medical attention is essential. Prompt diagnosis and the early initiation of debridement can significantly increase the chances of a positive outcome. Therefore, it is important to seek medical help if there is a suspicion of infection.

Early and aggressive debridement may also be more successful at stopping the spread of infection and preventing further operations.

In addition, debridement under general anaesthetic may not be possible as the condition progresses because the body may become unable to withstand the effects of surgery as organs shut down, making the case for early intervention even clearer.

Debridement and mental health

Debridement can have significant effects on the mental health of the individual and the people around them. It is important to address such mental health issues as early as possible and charities, such as the Katie Piper Foundation, can help with rehabilitation.

You can read more about how the the Life-Changing Rehabilitation Services of the Katie Piper Foundation in our article.

Links to other organisations who can help following debridement.

The Sepsis Trust

The UK Sepsis Trust (UKST) exists to fight this life-threatening condition, which is related to necrotising fasciitis, to stop preventable deaths and support those affected by sepsis and recovering from critical care.

Changing Faces

Changing Faces is a leading UK charity for everyone with a scar, mark or condition on their face or body. They have great resources and support for the potential psychological impact of debridement in the treatment of necrotising fasciitis.

Mind

Mind is a charity that was set up to offer support to everyone experiencing mental health problems. They can help with trauma and post traumatic stress which can be associated with necrotising fasciitis.

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Amputation in the Treatment of Necrotising Fasciitis

Necrotising fasciitis is a rare and life-threatening condition normally caused by a bacterial infection affecting the skin's deeper layers, including the fascia and muscles. It spreads rapidly and can lead to tissue death and organ failure if left untreated. In some...

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