Planned Surgical Interventions Avoided in Necrotizing Fascitis and MRSA Wounds: A Case Series Using Noncontact Low-Frequency Ultrasound*

Purpose: Resolution of wound infection is essential to prepare wound beds for planned graft or flap procedures. Noncontact low-frequency ultrasound (NLFU), which is indicated for maintenance debridement of slough, fibrin, tissue exudates, and bacteria,¹ has also been shown to accelerate healing in chronic lower-extremity wounds.^2-5 Ultimately, if surgical interventions can be avoided entirely, healthcare resources are saved and patient morbidity is minimized.

Case Series: NLFU was administered thrice weekly (3-20 min) in wounds with necrotizing fasciitis or MRSA. A 59-year-old woman was admitted with a Stage III sacral pressure ulcer (3 months without progress) and open fasciotomy of the thigh with necrotizing fasciitis s/p surgical debridements/fasciotomy, skin graft (partial take). After 2 weeks of NLFU with calcium alginate (sacrum) and nonadherent foam (thigh), planned flap (sacrum) and graft (thigh) procedures were cancelled thanks to 20-30% increases in granulation and epithelialization and marked volume reductions (thigh 533 cm³ to 10 cm³; sacrum 14.7 cm³ to 2.6 cm³) . A 74-year-old diabetic man was admitted with an MRSA-positive perirectal abscess 0.5 cm from the anal opening of the buttock s/p surgical debridement. After 2.6 weeks of NLFU with NS gauze dressing, volume was reduced from 75 cm³ to 8 cm³. Planned colostomy for fecal diversion was cancelled. A 72-year-old paraplegic man was admitted with denuded, irritant dermatitis surrounding chronic pressure ulcers (buttock 194 cm³, trochanter 2.6 cm³, sacrum 0.15 cm³, thigh 1.2 cm³) with necrotizing fasciitis s/p debridements. After 2 weeks of NLFU and antifungal moisture barrier, irritated/denuded areas resolved, sacrum and thigh ulcers closed, and buttock (168 cm³) and trochanter (0.8 cm³) ulcers are on healing trajectories that negated the need for planned flap surgery. Implications: NLFU helped set these necrotizing fasciitis and MRSA-positive wounds on healing trajectories, resulting in avoidance of planned surgical interventions.