In "Necrotizing Fasciitis" (Emergency, September), the topical treatment described is wet-to-dry dressing after serial debridements. Another valuable treatment option wasn't mentioned-vacuum-assisted wound closure, in which negative pressure is externally applied.

I have used this procedure on many patients diagnosed with necrotizing fasciitis after surgical debridement. Immediately afterward, the wound appeared much smaller and was sealed from external contamination. The usual multiple painful dressing changes (wet-to-dry) were reduced to one every other day. These patients no longer faced general anesthesia for serial debridements. Vacuum-assisted wound closure removed excess wound exudate and decreased edema and bacterial load. When able, the patients walked without fear of leaving behind a trail of soiled dressings.

As part of a comprehensive treatment plan for necrotizing fasciitis, vacuum-assisted closure can decrease length of stay, morbidity, and mortality.

Kathy Gibson, MSN, RN, CS, CWOCN

Stockton, CA