Against All Odds; Necrotizing Fasciitis, Multiple Comorbidities, Home in 50 Days

Purpose:   Obese patient with stay of 50 days, 850 miles from home, admitted with sepsis, compounded by necrotizing fasciitis, numerous co-morbidities.  Mobility issues secondary to body habitus, strict limitations necessary for optimal wound healing post multiple extensive surgeries.

Approach: 47 year old female, from GA, travels with truck driver husband (sleeping on mattress with springs exposed) Admitted with RLE weakness, distal sensory loss & urinary incontinence. Found to be in severe septic shock, ARF & with L gluteal necrotizing fasciitis. Multiple co-morbidities: obesity, DM, HTN, etc.. Condition unstable upon arrival, admitted to ICU, intubated, on vasopressors & antibiotics. Received multiple debridement of the left gluteal muscle and partial resection of the labia. NPWT placement followed with complex closure of LLE gluteal/thigh wound along with sacral reconstruction & diversional colostomy.  Case complicated by SBO, depression, C.DIFF, RLE neuropathy & foot drop. A comprehensive approach via Physicians, Surgeons, Wound Care, Nursing, Rehabilitation, Social work, Dietary, Family resulted in successful outcome minimizing life threatening complications.

Result: Extensive wound care performed daily prior to flap. Followed by complex flap of left gluteal and left posterior thigh, plastic surgeon continued to work closely with PT/OT and nursing staff regarding patient limitations critical for flap healing and prevention of tissue necrosis.  From admission to discharge patient hospitalized for a total of 50 days.  Endless hours of communciation were spent to ensure safe discharge to a rehab facility near patients’ home in Georgia; once patient able to stand independently, to endure flight & necessary frequent repostioning. Upon discharge patient ambulatory with rolling walker.

Conclusion: Management of wounds, infection, emotional support, aggressive rehabilitation resulted in ideal patient outcome. Successful discharge achieved due to collaboration of multiple disciplines, supported by administration & spouse preventing all possible poor outcomes for discharge.