The Value of Silver Nitrate in Controlling Necrotizing Fasciitis

Arch Surg. 1974;109(5):718. doi:10.1001/archsurg.1974.01360050112023.
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To the Editor.–Rhea and Wyrick report 30% mortality in 44 cases of necrotizing fasciitis.1 Quintiliani and Engh report seven similar cases, with four deaths.2

Two additional cases are presented with control through silver nitrate soaks.

Case 1.–In 1966, a 27-year-old woman was admitted with presumptive diagnosis of gas gangrene of the left buttock. Smear showed no Clostridium. Incision and drainage of a horseshoe abscess was performed, and massive antibiotic therapy begun, with alterations instituted when failure was apparent. Debridement was performed in the isolation unit without anesthesia. A regimen of activated zinc peroxide was begun on the 20th day with good response; however, by the 26th day all available supplies were exhausted. Continuous soaks of 0.5% silver nitrate were begun. Administration of all antibiotics was stopped and, although the posterior musculature of the left buttock to ankle formed the bed of a Meleney ulcer, she was transferred well


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