Treatment of Extensive necrotizing abdominal wall infection

Michael Schurr, MD
Mountain Area Health Education Center; Asheville, NC


Patient Presentation

  • In April of 2020, a 56-year-old female presented with an incarcerated ventral hernia which led to necrosis of the strangled intestinal tissue and abdominal wall.
  • Consequently, she was in septic shock.
  • Extensive intestinal and abdominal surgery was performed to remove necrotic tissue and fix hernia.
  • Intestines were reattached using the stapled ileocolonic anastomosis method.
  • Delayed wound closure and healing by secondary intention was chosen to monitor for infection before closing.

Adjunct Therapies

  • NPWT
  • Systemic antibiotics

Procedure & Treatment

  • After extensive intestinal surgery, 14 pieces of Microlyte® Surgical 4”x 4” sheets were placed on the wound and left to heal by second intention for approximately 2 weeks.
  • When wound was confirmed as infection free, then closed with sutures.
  • A wound vac was placed to manage drainage and promote healing.
  • Wound was checked approximately once a month, for 3 more months.

Clinical Outcome

  • One month after abdominal closure, patient’s incisional sutures were still in place and wound vac still secure. Some undermining was noted.
  • One month later, patient continued to do well, and undermining was resolved. Exudate was minimal and free of purulence.
  • At month three, she continued to improve with only lateral aspects of the wound open. NPWT was continued. No drainage or erythema was observed.
  • Patient is free of infection and wound is greater than 90% healed with small lateral aspects remaining open which is being treated with Microlyte® Surgical.


  • Ventral hernia repairs have an SSI rate of up to 23%, and incarcerated hernias are associated with a poor prognosis. Necrotizing infections are severe conditions with a high mortality rate due to sepsis and the subsequent multi-organ failure. And bowel resection, as this patient experienced, adds another layer of risk.
  • The addition of Microlyte® Surgical to the surgical protocol may have been instrumental in controlling the bioburden of the wound, thereby allowing the wound to progress out of the inflammatory stage and onto healing.
  • Microlyte® Matrix shows promise as an adjunctive therapy when healing by second intention is indicated.

Figure 1:
A. 14 sheets of Microlyte Surgical were used as the primary dressing after debridement.
B. Wound is greater than 90% healed and free of infection

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