Diagnostics and surgical tactics for necrotizing soft tissue infection

Objective: To improve the effectiveness of diagnosis and surgical management of necrotizing fasciitis of the soft tissues. Materials and methods: We analyzed 68 patients with necrotizing soft-tissue infections: necrotic erysipelas (n=27), necrotizing fasciitis (n=31), and myonecrosis (n=10). Assessment included clinical evaluation, laboratory testing, point-of-care ultrasonography (POCUS), radiography/Doppler studies, transcutaneous oxygen tension (TcPO2; mean 35.8±2.4 mmHg prior to reconstructive procedures), wound microbiology with antibiograms, and cytology of wound exudate. Surgical strategy comprised emergent wide necrectomy with repeat explorations within the first 12-24 hours, drainage, and negative-pressure wound therapy (NPWT); when indicated, split-thickness skin grafting with perforated autografts was performed. Results: Early POCUS detected fluid collections within fascial planes and soft-tissue gas, expediting urgent surgery (in most cases within 6 hours of admission). NPWT facilitated rapid control of exudation, maturation of granulation tissue, and readiness for coverage: complete graft take occurred in 75% of cases and partial take in 18.7%. Major amputations were required in 13 patients; overall mortality was 23.5% (16 deaths). Cytology reflected a shift from acute purulent inflammation to reparative changes (increased macrophages and fibroblasts) during therapy. Conclusion: A comprehensive algorithm-early POCUS verification, immediate radical necrectomy with staged re-explorations, NPWT, selective reconstruction-combined with etiotropic antibiotic therapy tailored to local susceptibility patterns, improves infection control, reduces local complication rates, and enhances preparedness for reconstructive procedures in patients with necrotizing soft-tissue infections.