Use of human acellular dermal matrix for wound healing in a patient with necrotizing fasciitis, after failure of autologous dermal / epidermal skin graft: A case report

Abstract

The use of human Acellular Dermal Matrices (hADMs) has been described in patients requiring treatment after skin burns, wounds with bone exposure, complex trauma wounds and breast surgery. We report a clinical case using hADM to close an open wound of the right foot caused by the penetration of part of a shell into the skin followed by necrotizing fasciitis, after multiple unsuccessful treatments using Negative Pressure Wound Therapy, porcine acellular dermal substitutes and a split-thickness skin graft. hADM appeared to be an appropriate adjunct for wound healing process in our patient with chronic open wound failing to heal. Introduction Skin and soft-tissue infections (SSTIs) include a variety of pathological conditions which involve the skin and underlying subcutaneous tissues, fascia or muscles, that may also cause necrotizing infections [1,2]. In 1998, the US Food and Drug administration (FDA) classified SSTIs in two main categories: uncomplicated and complicated. Uncomplicated SSTIs are represented by superficial infections as furuncles, abscesses, cellulitis and/or impetigo requiring antibiotic or surgical procedures, whereas complicated SSTIs are represented by deep soft tissue infections such as necrotizing infections, infected ulcers, infected burn and major abscess requiring surgical intervention with drainage and debridement [3,4]. The use of human Acellular Dermal Matrices (hADMs) has been reported mainly after skin burns or cosmetic and reconstructive procedures [5]. These applications can be performed successfully since hADMs have the ability to incorporate into host tissue and allow cellular and vascular ingrowths, without eliciting any biologic inflammatory response and avoiding infection [6,7]. We reported a clinical case using hADM to close an open wound of the right foot caused by necrotizing fasciitis after multiple treatment failures. Case presentation On July 2018, a 48-year-old non-smoker and non-diabetic healthy man had small open wounds of the right leg and plantar foot as a consequence of the penetration of part of a shell into the skin. After 12 hours, he experienced high fever caused by an infection involving locally the skin and subcutaneous tissues up to the muscular fascia (Figure 1). The patient was admitted to the intensive care unit for *Correspondence to: Giampietro Bertasi, Via Molino 43, San Pietro in Cariano, Italy, Tel: +393456001037; E-mail: bertasi.g@sis.it