Necrotizing Fasciitis (Vrana / Dushta Vrana): An Integrative IMRAD Review with Modern and Shalyatantra References

Abstract

Background: Necrotizing fasciitis (NF) is an aggressive, rapidly progressive soft-tissue infection of fascial planes and subcutaneous tissue that can lead to systemic toxicity and high mortality without prompt surgical intervention. Ayurveda describes severe, foul, destructive wounds under the rubric of Dushta Vrana; classical Shalyatantra prescribes surgical and para-surgical measures for cleansing and healing. Methods: Narrative IMRAD review integrating contemporary surgical literature (diagnosis, emergency management, outcomes) with classical Ayurvedic texts (Sushruta Samhita and related commentaries) and recent Ayurvedic case reports addressing wound management. Results: Modern management prioritizes urgent wide surgical debridement, broad-spectrum intravenous antibiotics and intensive supportive care. Ayurvedic Shalyatantra provides principles—cheda (excision), vrana-shodhana (cleansing), kshara and agni karma (chemical and thermal measures), and ropana (healing) therapies—that conceptually align with modern goals of source control and wound bed preparation. Evidence for Ayurvedic adjuncts in NF is limited to case reports and small observational series. Conclusion: In acute NF, modern surgical care is essential and non-negotiable. Ayurvedic measures may be considered as adjunctive local therapy after stabilization and adequate source control, in a multidisciplinary framework. Standardized clinical research is needed to establish safety, timing, and efficacy of Ayurvedic wound regimens in the post-debridement phase.