关键词: 坏死性筋膜炎, 　负压封闭引流, 　感染, 　植皮, 　压疮

Abstract: Objective　 To summarize the treatment experience of acute necrotizing fasciitis and provide reference for clinical practice. Methods　A retrospective analysis was conducted on the clinical data of six patients with acute necrotizing fasciitis from June 2021 to October 2024. The changes in wound characteristics， abnormal laboratory indicators， surgical methods and frequency， treatment of complications， length of hospital stay， and follow-up of wounds after discharge were analyzed. Results　After admission， all the 6 patients had fever， elevated hemogram， and excessive inflammatory indexes of C-reactive protein and procalcitonin. One patient had extensive redness， swelling， and pain in the right thigh skin， with high skin temperature， tenderness， and obvious fluctuant sensation. In addition， five patients had skin ulceration and necrosis accompanied by exudate， and the surrounding skin was red， swollen， hot， and painful. Five patients had a history of type 2 diabetes， two patients had stage IV pressure sores in the ischial tuberosity （one was bilateral）， and one patient had grayblack erosion and necrosis of the second and third toes of the right foot. After admission， all patients received empirical anti infective treatment by intravenous drip of antibiotics， and actively regulated blood glucose. After 2-6 days， all patients received wound debridement and vacuum sealing drainage， and then adjusted the anti infective treatment of antibiotics according to the results of wound bacterial culture. All patients had anemia， electrolyte disorder， hypoproteinemia and  abnormal coagulation function， and were given corresponding symptomatic treatment. Two cases were complicated with pleural effusion， and one case received closed thoracic drainage. All patients were treated with debridement and vacuum sealing drainage， and the method of“ conservative debridement of superficial fascia and thorough debridement of deep fascia” was adopted. Among them， 1 case underwent 6 times of debridement and vacuum sealing drainage， 3 cases underwent 1 time， 1 case underwent 2 times， and 1 case reached the repair standard of granulation tissue bright red and no inflammatory reaction after 3 times. Five patients’ wounds were closed by direct suture， one patient received skin graft closure and toe amputation， and the patient with sciatic nodule pressure ulcer received gluteus maximus myocutaneous flap repair at the same time. After debridement and vacuum sealing drainage， the inflammatory indexes of all patients decreased significantly， the body temperature gradually returned to normal， and the abnormal laboratory indexes gradually tended to be normal. The hospital stay was 24-91 days. No recurrence of necrotizing fasciitis was found during the follow-up of 3-40 months after discharge. Conclusion　 The treatment of acute necrotizing fasciitis needs to consider many factors. Active anti infection treatment， blood glucose control and correction of abnormal laboratory indicators to maintain the balance of the body’s internal environment are the basis of treatment. Early conservative debridement of superficial fascia and thorough debridement of deep fascia combined with vacuum sealing drainage are very important to control the progress of the disease， which can retain the skin tissue on the surface of necrotic fascia to the greatest extent. After the granulation tissue of the wound is fresh and has no inflammatory reaction， the wound can be effectively cured by direct suture or skin grafting.

Key words: Necrotizing fasciitis, 　Vacuum sealing drainage, 　Infection, 　Skin grafting, 　Pressure ulcer