Abdominal wall reconstruction after necrotizing soft tissue infections with tissue loss

Necrotizing soft-tissue infection (NSTI) is infrequent but highly lethal. Mortality for NSTI has been reported to range from 21 to 43% in single-center studies. [1, 2] Larger studies have shown mortality as great as 34%,[3] but more recent studies have shown a decrease in mortality to 10-23.5%. [4-7] They can be defined as infections of any of the layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle) that are associated with necrotizing change. Though typically not associated, NSTIs can originate from inadequately or untreated drained abscess. NSTIs can originate from inside and out of the abdominal wall. When NSTI is suspected, emergent medical and surgical intervention must occur. All diseased tissue must be removed. Because these infections strike quickly along vast fascial planes, resultant defects are significant and involve the strong fascial layer. This confers both a soft tissue and functional deficit, and poses a considerable reconstructive challenge. Once infection has cleared, a staged reconstructive approach should be pursued. Appreciation of the function and anatomy of the abdominal wall, and reconstructive principles, is critical.