Management of Necrotizing Fasciitis

Fundamental Principle of Surgical Management

The wound should always be left open after initial debridement and subsequent debridements, as recommended by the World Journal of Emergency Surgery, to reduce mortality and morbidity 1, 2, 3

The first re-exploration should be planned within 12-24 hours following the initial operation, to assess the need for further debridement 1, 2, 3
Re-explorations should be repeated every 12-24 hours until the patient is free of necrosis, to ensure timely removal of dead tissue 1, 2, 3
Re-explorations may be necessary earlier if clinical signs of infection worsening or laboratory parameters deterioration become evident, such as an increase in white blood cell count 1, 2

Delayed re-debridement after initial source control in necrotizing infections leads to poor outcomes, reduced survival, and increased incidence of acute renal failure, emphasizing the importance of prompt surgical intervention 1, 2, 3
Preservation of viable skin is recommended during the initial operation, and if skin viability is doubtful, skin preservation and re-evaluation during the second operation are indicated, to minimize tissue loss 2, 3, 5

Never primarily close a necrotizing fasciitis wound with staples, sutures, or any other means of closure, as this can lead to rapid progression of infection, increased mortality, and need for more extensive debridements 1, 2, 3