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Multiple skip incision skin-sparing debridement for perianal necrotizing fasciitis: a retrospective study
Qing Long1, Chaochi Yue1, Bin He1
1Department of Anorectal Surgery, The Affiliated Hospital, Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, Sichuan, 646000, China.
Aim:
Multiple skip incision skin-sparing debridement (MSISSD) is a surgical procedure that excises infected tissue to achieve source control while retaining the infected but viable skin, thus overcoming some limitations of traditional surgical debridement. We aimed to introduce this skin-sparing debridement technique for the treatment of perianal necrotizing fasciitis (PNF) and retrospectively analyze its efficacy and safety.
Methods:
Patients with PNF who received MSISSD between January 2021 and August 2024 were included in this retrospective analysis. We investigated the patient characteristics (sex, age, disease duration, and LRINEC score) and clinical data (comorbid diseases, length of stay in the intensive care unit [ICU LOS], microbiological culture results, number of debridements, length of stay [LOS], wound healing time, treatment outcomes, and follow-up status).
Results:
Twenty-two patients with PNF were enrolled, including 19 males (86%) and three females (14%). The median age, disease duration, and LRINEC score was 59.5 years (range: 26-77), 4.5 days (range: 2-10), and 4 (range: 1-10), respectively, and five cases had a LRINEC score ≥ 6 (23%). Among the 22 patients included, the most common comorbid disease was diabetes, with nine cases (41%). Nine (41%) patients were admitted to the ICU, with a median ICU LOS of 2 days. Of the patients with positive wound cultures (14, 64%), polymicrobial infections were identified in 3 (21%) and monomicrobial infections in 11 (79%). The most commonly isolated microorganisms were Escherichia coli (8, 57%) and Klebsiella pneumoniae (5, 36%). One patient underwent debridement twice, while the remaining patients underwent debridement once. The median LOS was 18 days, and the wound healing time was 61 days. No patient underwent reconstruction surgery. During the median follow-up period of 11 months, one patient developed anal fistula 6 months after surgery and recovered after undergoing anal fistula resection. No patient experienced recurrence of PNF or anal incontinence.
Conclusion:
MSISSD appears to be a promising and effective method for skin protection debridement, which can effectively protect the skin while ensuring adequate drainage, and rarely causing severe anal dysfunction.
Insights
Multiple skip incision skin-sparing debridement (MSISSD) effectively treats perianal necrotizing fasciitis (PNF) by preserving viable skin. This technique ensures adequate drainage and rarely causes severe anal dysfunction, offering a promising surgical option.
Area of Science:
- Surgical Oncology
- Infectious Diseases
- Dermatology
Background:
- Perianal necrotizing fasciitis (PNF) is a severe soft tissue infection requiring prompt surgical intervention.
- Traditional debridement methods can lead to significant skin loss and functional impairment.
- Multiple skip incision skin-sparing debridement (MSISSD) aims to preserve viable skin while achieving source control.
Purpose of the Study:
- To introduce the MSISSD technique for PNF treatment.
- To retrospectively evaluate the efficacy and safety of MSISSD in PNF patients.
Main Methods:
- Retrospective analysis of 22 PNF patients treated with MSISSD (January 2021 - August 2024).
- Data collected included patient demographics, disease characteristics (LRINEC score, duration), comorbidities, ICU and hospital length of stay (LOS), microbiological findings, debridement frequency, wound healing time, and outcomes.
- Follow-up status and complications were assessed.
Main Results:
- The study included 22 patients (86% male, median age 59.5 years).
- Common comorbidities included diabetes (41%). Median LRINEC score was 4.
- Polymicrobial infections were common (21%), with Escherichia coli and Klebsiella pneumoniae being frequent isolates. Median LOS was 18 days, and wound healing time was 61 days. No reconstruction surgery was needed.
- One patient developed an anal fistula, successfully treated. No recurrence or anal incontinence was observed.
Conclusions:
- MSISSD is a promising surgical debridement technique for PNF.
- It effectively protects the skin, ensures adequate drainage, and minimizes the risk of severe anal dysfunction.
- MSISSD offers a safe and effective approach for managing PNF.
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