Open AccessApproaches to Surgical Debridement in Necrotizing Soft Tissue Infections: Outcomes of an Animated, Interactive Survey
Author(s) -
Suijker Jaco,
Hofmans Fabienne A. C.,
Zuijlen Paul P. M.,
Cense Huib A.,
Bonjer H. Jaap,
Vries Annebeth Meijde
Publication year - 2022
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-022-06470-8
Subject(s) - medicine , surgery , debridement (dental) , fascia , plastic surgery , deep fascia , septic shock , vascular surgery , sepsis , necrotic tissue , soft tissue , erythema , cardiothoracic surgery , general surgery , cardiac surgery
Background Necrotizing soft tissue infections (NSTI) affect long‐term quality of life in survivors. Different approaches to debridement may influence quality of life. The aim of this study was to assess the current practice of the debridement of NSTI in the Netherlands. Methods An animated, interactive online survey was distributed among general surgeons and plastic surgeons in the Netherlands. Two NSTI‐cases were presented, followed by questions regarding the preferred surgical approach. Case one described a woman with a swollen, red leg, with signs of sepsis and without visible necrosis. Case two described an immunocompromised man with septic shock syndrome and extensive necrosis. Results In total 232 responses were included (143 general surgeons, 89 plastic surgeons). In case one, 32% chose to preserve all skin, while 17% chose to resect all skin above the affected fascia, including normal‐looking skin. In case two, all participants resected necrotic skin, and most (88%) also blue discolored skin. While 32% did not resect more than blue discolored and necrotic skin, 35% also resected red‐colored skin, and 21% all skin overlying the affected fascia, including normal colored skin. Respondents working in a hospital with a burn center tended to preserve more skin, whereas plastic surgeons chose more often for skin resection compared to general surgeons. Conclusions By using a novel approach to a survey, the authors demonstrate the existence of extensive practice variety regarding the approach to debridement of NSTI among Dutch general and plastic surgeons. Consensus is needed, followed by targeted education of surgeons.