Staged Comprehensive Management for Necrotizing Fasciitis of the Lower Extremity with Sepsis: A Case Report

Summary

A previously healthy man with acute necrotizing fasciitis and sepsis underwent bedside incision, staged debridement, antibiotics, insulin, VSD, and skin grafting. Limb salvage and return to normal life at 1-year follow-up illustrate the value of timely diagnosis and a multidisciplinary staged approach.

Abstract

Necrotizing fasciitis is a severe soft tissue infection characterized by rapid necrosis of the skin, subcutaneous tissue, and fascia. Its onset is sudden, and progress is rapid. Complications such as sepsis, septic shock, and multiple organ dysfunction syndrome (MODS) can appear early, leading to high mortality and disability. The early symptoms lack specificity, posing diagnostic challenges and a high risk of misdiagnosis. This case report describes a 37-year-old male patient who presented with progressive redness, swelling, and pain of the left lower limb. Bedside incision and exploration under local anesthesia confirmed acute necrotizing fasciitis. Staged comprehensive management included early surgical debridement, empirical antibiotics, anti‑shock therapy, vacuum sealing drainage, and eventual skin grafting. The patient’s limb was salvaged, and at 1-year follow-up, he had returned to normal daily activities. This case may provide limited insights for the clinical management of similar patients, particularly regarding the importance of timely bedside exploration and a multidisciplinary, staged approach.

Introduction

Necrotizing fasciitis is a rare, serious, and potentially life-threatening infectious disease. This disease is caused by the invasion of pathogenic bacteria into the body, and is characterized by progressive infection and necrosis of deep fascia, superficial fascia, skin, and subcutaneous tissue. The onset of the disease is acute, and the condition is rapid. Severe cases can cause systemic inflammatory response syndrome (SIRS), septic shock, multiple organ dysfunction syndrome (MODS), and even death^1,2. Because early clinical manifestations lack specificity, diagnosis is often delayed or missed. Eve....

Protocol

1. Early diagnosis

NOTE: Early clinical symptoms are not typical and are easily confused with other soft tissue infections. Although auxiliary examination methods such as color Doppler ultrasound and computed tomography are available in clinical practice, timely incision and exploration remain the standard for a clear diagnosis.

1. Local anesthesia was administered at the site where palpation fluctuation was most obvious. A small incision (≤ 5 cm) was made through the skin and subcutaneous tissue.
2. The incision was explored with blunt dissection to assess the underlying fascia.
3. The pre....

Results

The patient was discharged from the hospital on December 14, 2023. Before discharge, the patient’s infection markers had returned to normal levels. The stamp skin graft on the left lower limb survived well, with no signs of necrosis or infection. Sensation and blood perfusion of the distal left lower limb were intact. However, the patient exhibited limited flexion of the left knee joint.

After discharge, the patient underwent a gradual, stepwise rehabilitation program. At the 1-year follow-up,.......

Discussion

In this single case of acute necrotizing fasciitis with sepsis, a staged comprehensive management approach was applied. The patient achieved a favorable outcome. Based on this experience and a review of the literature, the following three key points are discussed below. It should be noted that, because this is a single case, the contribution of each individual component of the staged approach cannot be separated, and the broader applicability of the approach remains to be determined.

The first.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
DISPOSABLE PULSED FLUSHING SYSTEM	SAC (XIAMEN) MEDICAL TECHNOLOGY CO., LTD.	6305005000	Specification:SAC-WPWS-1000
Vacuum Sealing Drainage Dressing	Wuhan VSD Medical Science & Technology Co., Ltd.	UDI-DI:06943246600075	Specification:VSD-D-2-15*10*1
Vacuum Sealing Drainage Dressing	Wuhan VSD Medical Science & Technology Co., Ltd.	UDI-DI:06943246600099	Specification:VSD-D-2-15*28*1
Insulin Injection	Fosun Wanbang (Jiangsu) Pharmaceutical Group Co., Ltd.	NDC:86901729000251	10 mL:400 units
Levofloxacin and Sodium Chloride Injection	Shandong Qidu Pharmaceutical Co., Ltd.	NDC:86904145002243	100 mL:levofloxacin (calculated as C18H20FN3O4) 0.5 g and sodium chloride 0.9 g
Meropenem for Injection	SCPC PHARMACEUTICAL GROUP LIMITED	NDC:86902777002372	0.5 g (calculated as C17H25N3O5S)
Ornidazole Injection	Hebei Kaiwei Pharmaceutical Co. Ltd.	ATC:J01XD03, P01AB03	3 mL:0.5 g
Ulinastatin for Injection	Techpool Bio-Pharma Co., Ltd.	NDC:86900344000189	100,000 units
Vancomycin Hydrochloride for Injection	Eli Lilly Japan KK Seishin Laboratories	NDC:86978400000084	0.5 g (500,000 units) (calculated as C66H75Cl2N9O24)