Smeets L, Bous A, Heymans O
Department of plastic and reconstructive surgery, CHU Liege.
Acta Chir Belg. 2007 Jan-Feb;107(1):29-36. doi: 10.1080/00015458.2007.11680007.
We report a case of necrotizing fasciitis of the lower limb. This medico-surgical emergency is a life-threatening invasive soft-tissue infection which primarily involves the fascia superficialis and rapidly extends along subcutaneous tissue with relative sparing of skin and underlying muscles. Clinical presentation includes fever, signs of systemic toxicity and pain out of proportion to clinical findings. Paucity of cutaneous findings early in the course of the disease makes diagnosis challenging. The confirmation of the diagnosis is often made after surgical debridement. Delay in diagnosis and/or treatment correlates with poor outcome, leading to sepsis and/or multiple organ failure. Radiologic studies including plain radiographs, CT-scan or MRI may help to diagnose necrotizing fasciitis. Prompt surgical debridement, intravenous antibiotics, fluids and electrolytes management and analgesia are mainstays of the therapy. Adjuvant treatments like clindamycin, hyperbaric oxygen therapy and intravenous immunoglobulins are discussed.
我们报告一例下肢坏死性筋膜炎病例。这种外科急症是一种危及生命的侵袭性软组织感染，主要累及浅筋膜，并沿皮下组织迅速蔓延，皮肤和深层肌肉相对较少受累。临床表现包括发热、全身中毒症状以及与临床检查结果不相称的疼痛。疾病早期皮肤表现较少，这使得诊断具有挑战性。诊断通常在手术清创后得以确认。诊断和/或治疗的延迟与不良预后相关，可导致败血症和/或多器官功能衰竭。包括X线平片、CT扫描或MRI在内的影像学检查可能有助于诊断坏死性筋膜炎。及时的手术清创、静脉使用抗生素、液体和电解质管理以及镇痛是治疗的主要手段。文中还讨论了如克林霉素、高压氧治疗和静脉注射免疫球蛋白等辅助治疗方法。
