Management of Fasciitis in a Mariner on a Disabled Sailboat in the Middle of the Pacific

Abstract

A 57-y-old sailor (Patient S) with a history of chronic lymphocytic leukemia departed from Hawaii on his sailboat. On the morning of his departure, he sustained a small laceration to his right foot while walking on the beach. During the next 1–2 d, this laceration became superficially infected. Four days after setting sail, a rogue wave hit the boat in bad weather, splitting the mainsail and damaging the ship's communication equipment. Over the next 3 d, Patient S experienced worsening of his wound infection to the point that by Day 7, when George Washington Maritime Medical Access was contacted to initiate medical management, Patient S had developed a full-fledged necrotizing fasciitis in his right lower extremity. Despite attempts to treat the infection while at sea, Patient S eventually required a complex medical evacuation from the middle of the Pacific Ocean.