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Plastic surgery in the treatment of Necrotising Fasciitis

Jan 25, 2024 | Awareness | 0 comments

Introduction

In this article, Helen Richards, Consultant Hand and Plastic Surgeon at Sheffield Teaching Hospitals, provides an insight in to the use of plastic surgery in the treatment of Necrotising fasciitis and how this field can assist in the, sometimes lengthy, recovery process.


Necrotising fasciitis (NF) is a diagnosis that will always get the attention of a surgeon. It is generally thought to be a rare disease but one that requires urgent treatment to give the best chance of survival.

The role of Plastic surgery throughout recovery and treatment

As a Plastic Surgeon, I have managed a number of these cases over my career and early recognition is the key to a good outcome. My role in the management of necrotising fasciitis is helping to make the diagnosis, liaising with anaesthetics and intensive care doctors as patients with NF will require management in an intensive care unit and most importantly, getting patients to theatre to treat the disease.

What do we do in theatre?

First priority is making sure the patient is safely asleep. They may require multiple different drugs to support their heart and lungs during their operation and there will often by more than one anaesthetic doctor looking after them. They will also require fluids to help support their circulation along with their antibiotics and pain relief.

My job is to remove the unhealthy/dead tissue as quickly as possible to prevent further spread. There is often at least two of us doing this as time is of the essence. Whilst removing dead tissue we are also looking to preserve important structures such as nerves and blood vessels whenever possible. Depending on where on the body is affected we may need input from other surgical teams eg urology or gynaecology. Sometimes we have to make the difficult decision to amputate a limb or part of a limb. This decision will be made by at least two Consultants and would only be done if we felt it was the only way to save a patient’s life.

After we have removed all the unhealthy tissue, we control any bleeding and get the patient wrapped up in bulky dressings as quickly as possible.

After theatre

Once we are satisfied that we have removed all the unhealthy tissue the patient will be transferred to the intensive care unit for ongoing care. Here the patient will continue antibiotics and other supportive drugs. They may also require filtration for their kidneys due to the effects of the disease. The patient will be reviewed regularly by the surgical team to ensure the disease is not continuing to spread as is sometimes the case. Patients often require multiple trips to theatre to ensure that all unhealthy tissue is removed as the condition evolves.

Once the patients’ blood results and general condition is improving we can think about reconstruction. This is often in the form of split skin grafts. These are very thin shavings of skin taken from healthy skin and placed over the wounds to allow them to heal.

Back to the ward and home after surgery

Once the patient is no longer requiring high levels of support, we can transfer them to a normal ward and start thinking about rehabilitation and home. Patients have generally suffered a significant amount of muscle wasting following their time in ICU so will be seen by physiotherapy teams to help with this, dieticians to help with diet supplementation and, of course, the surgical team will continue to review to ensure they are continuing to improve. Some patients will need an occupational therapy assessment to make sure they can manage at home, particularly if they have undergone amputation.

Once home, there will still be multiple hospital visits for dressing changes, scar management and psychology support. Patients will also be reviewed by the surgical team to see if any more future surgery is required.

As you can see, using plastic surgery in the treatment of necrotising fasciitis together with other supporting treatments, is a long and involved process and is a very difficult time for patients and their families. As surgeons, we will always do our best to support our patients throughout this time.

You can find out more about other supporting treatments here.

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