Cost Effective & Accessible In-house Negative Pressure Wound Therapy in Managing Facial Necrotising Fasciitis

Necrotising fasciitis (NF) is a potentially fatal infection involving the subcutaneous tissue and fascia. The incidence of NF in maxillofacial region is very rare, accounted for only 3% to 4% of all cases compared to other common sites such as limbs, abdomen and groin. Traditionally, the treatment of this disease will be prolonged because it required multiple series of wound debridement, dressing and adjunct with the course of systemic antibiotics. Trend has been shifted to versatile negative pressure wound therapy (NPWT) which fasten wound healing, thus reduce the treatment time. It involves placement of a microporous foam sponge onto the surgical wound bed, a sealed occlusive plastic drape and a suction tubing device to be applied in ordered to create controlled negative pressure. By understanding the concept, we managed to innovate cost effective and accessible NPWT. In this case report, we presented 3 patients with maxillofacial NF, successfully treated using our in-house NPWT. An occlusive plastic seal, paraffin dressing and foam sponge, were applied and connected to the wall-mounted suction with nasogastric tube. Following extensive wound debridement of all cases, in-house NPWT initiated. Dressing were changed every 3 days according to the customised protocol. The treatments were continued until the evidence of healthy wound bed. Second stage surgery for case 1 and 2 were then reconstructed with split thickness skin graft (STSG), while case 3 was closed primarily with local advancement flap. The time required for in-house NPWT prior to second stage surgery ranged between 7 to 16 days for all cases.There were no evidence of surgical site infection. With the cost effectiveness of our in-house NPWT, it does help in managing cases of NF despite the number of existing resources are limited. Therefore, we recommended that in-house NPWT could be applied in oral maxillofacial region at all centres.