Name of the Procedure:

Debridement of Skin, Subcutaneous Tissue, Muscle and Fascia for Necrotizing Soft Tissue Infection; Abdominal Wall, with or without Fascial Closure.

Summary

This procedure involves the surgical removal of dead, damaged, or infected tissue from the abdominal wall due to a serious infection known as necrotizing soft tissue infection. The goal is to clean the infected area and promote healing.

Purpose

The procedure addresses necrotizing soft tissue infection, a severe and rapidly spreading infection that can destroy skin, muscle, and tissue. The primary goals are to remove the source of the infection, prevent the spread, and promote recovery.

Indications

• Rapidly spreading infection with severe pain, redness, and swelling.
• Presence of necrotic (dead) tissue identified via clinical assessment or imaging.
• Systemic symptoms such as fever, low blood pressure, and signs of sepsis.
• Patients with immune system compromise or chronic conditions making them susceptible to severe infections.

Preparation

• Fasting for at least 8 hours before the procedure.
• Temporary discontinuation or adjustment of certain medications (e.g., blood thinners).
• Preoperative blood tests and imaging studies such as CT or MRI scans to assess the extent of infection.
• Intravenous antibiotics started before surgery.

Procedure Description

1. The patient is placed under general anesthesia to ensure they are unconscious and pain-free.
2. The surgeon makes an incision in the abdominal wall to access the infected area.
3. Using surgical instruments, the surgeon removes all necrotic and infected tissue from the skin, subcutaneous tissue, muscle, and fascia.
4. The area is thoroughly irrigated with a sterile solution to clean out any remaining bacteria or debris.
5. Depending on the extent of tissue removal, the incision may be closed immediately or left open to heal by secondary intention, potentially involving additional surgeries.
6. Drains may be placed to prevent fluid accumulation and promote healing.
7. The surgical site is dressed and covered with sterile bandages.

Duration

The procedure typically takes between 1 to 3 hours, depending on the extent of the infection and the amount of tissue to be removed.

Setting

The procedure is performed in a hospital operating room due to the need for sterile conditions and comprehensive medical support.

Personnel

• Surgeon specialized in general or plastic surgery.
• Anesthesiologist for administering and monitoring anesthesia.
• Surgical nurses and operating room technicians.
• Infectious disease specialist may be consulted pre- and post-surgery.

Risks and Complications

• Infection at the surgical site
• Blood loss requiring transfusions
• Damage to surrounding organs or tissues
• Anesthesia-related complications
• Extended hospital stay and intensive care if complications arise
• Possible need for reconstructive surgery later

Benefits

• Removal of infected and necrotic tissue to halt the spread of infection.
• Reduction in systemic symptoms and stabilization of the patient’s condition.
• Enhanced likelihood of recovery and healing.

Recovery

• Postoperative care includes intravenous antibiotics, pain management, and wound care.
• Hospital stay may last from several days to weeks, depending on recovery progress.
• Follow-up appointments to monitor healing.
• Physical activity may be restricted and gradual rehabilitation might be necessary.

Alternatives

• Antibiotic therapy alone, suitable only for minor infections that do not require surgical intervention.
• Hyperbaric oxygen therapy to enhance tissue healing.
• Non-surgical debridement methods, such as using special dressings or enzymatic agents, which may be less effective for severe cases.

Patient Experience

• The patient will be under general anesthesia during the procedure and will not feel anything.
• Postoperative pain and discomfort are managed with medications.
• Initial recovery involves close monitoring, frequent dressing changes, and potentially the use of wound vac therapy.
• Emphasis on multidisciplinary care, involving dietitians, physical therapists, and wound care specialists to promote holistic recovery.