Limb-saving integrative Chinese-western therapy for necrotizing fasciitis: A case report and literature review

Necrotizing fasciitis (NF) of the lower leg is a severe, potentially fatal aggressive infection. Untimely treatment frequently leads to amputation or even life-threatening outcomes.

This case report presents a limb-salvage and life-saving strategy integrating Traditional Chinese Medicine (TCM) and Western medicine in a 93-year-old male patient with lower extremity necrotizing fasciitis who refused amputation. The integrated treatment plan included: early surgical incision with debridement, nose ring drainage, broad-spectrum antibiotics, and symptomatic supportive therapy. Local wound irrigation was performed with rhubarb-licorice decoction, supplemented by topical galla chinensis paste application and oral administration of Si-Miao-Yong-An Decoction and Siwu Decoction. During the intermediate phase, limited additional debridement was performed, followed by local chymotrypsin and lithospermum gauze application. After optimal wound bed preparation, split-thickness stamp skin grafting was performed. Postoperatively, Vaseline gauze and lithospermum gauze were applied alternately with intermittent closed drainage. The oral TCM regimen was subsequently adjusted to Buzhong Yiqi Decoction.

This integrative approach effectively addressed infection control, systemic inflammation, and tissue regeneration, demonstrating its potential as a limb-preserving alternative for NF patients when standard surgery is contraindicated or declined. Further studies are warranted to validate these findings.