4 658.12 29.37 5.4 16     18.3   Abbreviations: DM diabetes mellitus, HTN hypertension, Pn pneumonia, TB tuberculosis, CVA cerebrovascular accident, CRF chronic renal failure, HBV hepatitis B, STSG split-thickness skin grafts. Case 1 A 59-year-old male patient had necrotizing fasciitis on his right thigh without a suspected initiating factor. The patient had been diagnosed with diabetes mellitus 20 years before. The general surgeons performed a fasciotomy on his left thigh with thorough debridement buy MK-8931 and wound irrigation. Two weeks

after initial management, the patient was transferred to the plastic surgeon for wound coverage. The fasciotomy wounds spanned the lateral aspect of thigh to buttock with an area of about 55 × 15 cm; this was covered with granulation tissue. The exposed wound showed contracted skin margins with partially necrotic subcutaneous tissues and fascia (Figure 1A). After 46 days of wound preparation following initial fasciotomy, the patient MLN2238 solubility dmso underwent NPWT-assisted dermatotraction (Figure 1B, C). After 14 days of treatment, the fasciotomy wound could be closed directly (Figure 1D).

Figure 1 Open fasciotomy wound closure with extended NPWT-assisted dermatotraction in necrotizing fasciitis; A 59-year-old male patient with necrotizing fasciitis on his right thigh showed contracted skin margins with necrotic tissues on the 14th day after initial fasciotomy. (A). After 46 days of wound preparation, the elastic vessel loop is applied for the dermatotraction in a shoelace manner (B). The extended NPWT assisted the underlying dermatotraction in closing the open fasciotomy wound

(C). After the 14 days of treatment, the fasciotomy wound could be closed directly (D). Case 2 A 62-year-old male patient developed painful swelling on his left thigh and lower leg without suspected initiating factors. The patient was transferred to our hospital antibiotic treatment at the local hospital failed. On admission, the patient showed bullae and swelling on the entire left very lower extremity with concomitant ongoing necrosis on posterior calf skin. An MRI scan revealed necrotizing fasciitis of the entire left lower extremity. The patient underwent emergent open fasciotomy of lower extremity with debridement (Figure 2A). After seven days of thorough wound debridement and irrigation, the patient underwent two cycles of extended NPWT-assisted dermatotraction for the open fasciotomy wound closure (Figure 2B). Except for the necrosed posterior calf skin, which was covered with split-thickness skin grafts, the open fasciotomy wounds were closed directly without tension (Figure 2C).