EP683 - Innovative Surgical Strategies for Postoperative Reconstruction in Necrotizing Fasciitis: A Case Report

Purpose/Background: Necrotizing fasciitis (NF) is a rapidly progressing, life-threatening soft tissue infection that typically results in extensive tissue necrosis and sepsis. While early surgical debridement and broad-spectrum antibiotic therapy are the cornerstone of treatment, postoperative functional recovery and aesthetic restoration remain significant challenges, particularly in severe cases involving large tissue defects. This case report explores how postoperative reconstructive techniques can improve functional recovery in NF patients, with a focus on restoring activity and quality of life, through advanced techniques such as tissue expansion, musculocutaneous flap reconstruction, and vacuum-assisted closure (VSD) therapy, without relying on small incision methods.

Methods/Interventions: We report a 67-year-old male patient who presented with perianal redness, pain, and abdominal bloating, eventually diagnosed with necrotizing fasciitis involving the perianal, scrotal, and abdominal regions. Following initial surgical debridement, the patient developed scar contracture, leading to restricted mobility and functional impairment. In the second surgery, innovative reconstructive procedures, including tissue expansion and musculocutaneous flap reconstruction, were performed to restore both appearance and function. These techniques were selected over traditional skin grafting methods due to their superior outcomes in functional recovery and aesthetic restoration. Postoperatively, VSD therapy was used to promote wound healing and minimize complications.

Results/Outcomes: The patient showed good postoperative recovery, with effective infection control and significant functional restoration. Tissue expansion provided a durable and flexible skin foundation, effectively avoiding the functional limitations commonly associated with traditional skin grafts. Musculocutaneous flap reconstruction ensured the restoration of functional structures in the perianal and scrotal areas, significantly improving the patient’s bowel function and overall mobility. VSD therapy facilitated wound healing and prevented complications such as wound dehiscence.

Conclusion/Discussion: This case highlights the crucial role of innovative postoperative reconstructive techniques in the management of necrotizing fasciitis, particularly in terms of significant functional recovery. The combination of tissue expansion, musculocutaneous flap reconstruction, and VSD therapy not only improved the patient's aesthetic outcomes but also restored normal function, particularly in terms of mobility. These innovative methods optimize postoperative management, reduce complications, and provide a new direction for future treatment of necrotizing fasciitis. Further studies should assess the long-term effects of these techniques, especially their application in different clinical settings.

after debridement


after plastic surgery