Split-Thickness Skin Grafting for Abdominal Wall Reconstruction after Necrotizing Fasciitis: A Case Report

Abstract

Necrotizing fasciitis is a rapidly progressive soft-tissue infection that requires immediate resuscitation, broad-spectrum antimicrobial therapy, and radical surgical source control. Survivors may be left with extensive defects that demand staged reconstruction. We report a 66-year-old woman with diabetes and active tobacco use who presented after three weeks of progressive left lumbar pain and swelling extending to the groin, thigh, and vulva. She arrived in profound shock (blood pressure, 60/45 mmHg) with purulent drainage and crepitus. Computed tomography demonstrated gas within the left psoas muscle and the lumbar, lumbosacral, and vulvar subcutaneous tissues, consistent with necrotizing fasciitis and a retroperitoneal abscess. She required intensive care, mechanical ventilation, multiple vasopressors, broad-spectrum antibiotics, serial radical debridement, drainage of the retroperitoneal collection, and repeated negative-pressure wound therapy. Because enteric effluent subsequently contaminated the wound system, a diverting rightsided colostomy was created. Once infection control and a healthy granulating bed had been achieved, abdominal cutaneous flap advancement and a meshed split-thickness skin graft harvested from the left leg provided definitive coverage. Late postoperative assessment showed durable wound closure. This case illustrates how staged source control, temporary negative-pressure wound management, selective fecal diversion, and timely autologous skin grafting can salvage a massive abdominal wall defect after necrotizing fasciitis.