Multidisciplinary management of a complex abdominal wound post necrotising fasciitis: a case study

Area of Science:

• Surgical case report focusing on abdominal wall reconstruction and wound management.

Background:

• Necrotising fasciitis is a severe soft tissue infection requiring urgent surgical intervention.
• Bowel perforation can lead to intra-abdominal sepsis and secondary infections like necrotising fasciitis.

Observation:

• A 59-year-old male presented with abdominal necrotising fasciitis originating from a bowel perforation through a prior drain site.
• The patient experienced a two-week delay in seeking medical attention, allowing for significant contamination.
• Enteric contents were found within the abdominal wall, indicating extensive intra-abdominal sepsis.

Findings:

• Surgical intervention involved extensive debridement of the abdominal wall.
• A double-barrel ileostomy was created within the debrided abdominal wall area.
• The resulting abdominal wound was large (approx. 424cm²) and subject to continuous enteric leakage and contamination.

Implications:

• This case highlights the challenges in managing large, complex abdominal wounds with continuous enteric contamination.
• Effective wound bed preparation and containment of enteric output are critical for healing in such scenarios.
• Delayed presentation significantly impacts the severity and management complexity of necrotising fasciitis secondary to bowel perforation.