Punch grafting for necrotising fasciitis: a case report

Until recently, autologous punch grafting was reported for the treatment of vitiligo and other skin diseases such as nevus depigmentosus, piebaldism and postinflammatory or chemical leukoderma, as well as for ulcers and leg lesions. However, no studies have investigated its use in managing complications arising from necrotising fasciitis, to the best of the authors' knowledge. Given the nature of this bacterial infection - which affects the full thickness of the skin in the lower limbs - the favourable results achieved with punch grafting in ulcers suggest promise for its application in necrotising fasciitis as well. The authors present the case of an older male patient with necrotising fasciitis on the left leg, treated with autologous punch grafting. His medical history included obliterative arteriopathy, type II diabetes, and orthotopic heart transplantation under immunosuppressive therapy. He was hospitalised for cellulitis with tissue necrosis. After antibiotic therapy and surgical debridement, he was treated with autologous punch grafting from April to October 2021. By the end of treatment, complete restoration of skin integrity was achieved. In conclusion, autologous punch grafting may represent a valuable alternative for treating extensive ulcerations caused by necrotising fasciitis - particularly in immunocompromised patients - given its technical simplicity and the resulting improvement in quality of life.