Longer wound closure time associated with flaps, multiple debridements

Multiple debridements and the use of flaps are associated with longer closure times on complex infectious wounds, according to a study presented at the American Society for Dermatologic Surgery virtual meeting.

“Necrotizing soft tissue infections can result in complex wounds,” Sarah Yumeen, MD, a dermatology resident at Brown University Warren Alpert School of Medicine, said. “Patients commonly undergo numerous debridements prior to consideration of closure of those wounds. In addition, associated hemodynamic instability and comorbidities frequently complicate admission course.”

Researchers conducted a retrospective cohort study and literature review of 47 patients with necrotizing soft tissue infections at one center from 2007-2017.

The average time to closure was 31.2 days, with most patients requiring between one to five operating room visits for closure.

Autograft was used in 70% of patients and local flap was used in 9% of patients, while 21% of patients received both treatments.

On both univariate and multivariate analysis, the number of procedures as well as the use for local flap were both associated with increased times to closure.

The use of substances, anti-coagulant medication or medical co-morbidities did not affect the time closure.

“The majority of patients requiring surgical wound management for necrotizing soft tissue infections were middle-aged, immunocompetent and nondiabetic,” Yumeen said. “We found that the increased number of debridements as well as use of flaps for closure were associated with time to closure. And interestingly, time to closure appeared to be independent of other patient- and wound-related factors that we investigated in our study.”