Corradino Bartolo, Toia Francesca, di Lorenzo Sara, Cordova Adriana, Moschella Francesco
Dipartimento di Discipline Chirurgiche e Oncologiche, Sezione di Chirurgia Plastica, Università degli Studi di Palermo, Italy.
Int J Low Extrem Wounds. 2010 Dec;9(4):152-4. doi: 10.1177/1534734610389598.
This study reports the case of a 55-year-old woman with diabetes with a necrotizing fasciitis of the right lower limb and the perineum, first admitted at the emergency department for septic shock with cardiac arrest, and later transferred to the department of surgery. Microbiological and histopathological examination confirmed the diagnosis of necrotizing fasciitis caused by Acinetobacter baumannii. A broad-spectrum antibiotic therapy was administered and later readjusted according to the results of microbiological culture. Intensive hemodynamic support was required. Wounds were dressed daily with a 3 percent boric acid solution and a silver sulfadiazine-impregnated dressing. An extensive surgical debridement was promptly performed and repeated until complete control of the infection. Wounds were finally covered with split-thickness skin grafts. The infection was overcome 35 days after admission. The graft take was 100%. Postoperative rehabilitation was required because of the functional limitation of lower limb movements. Follow-up at 6 months showed no functional deficit and an acceptable aesthetic result. Necrotizing fasciitis is a life-threatening disorder, especially in patients with diabetes, whose clinical diagnosis may sometimes be challenging. Early recognition and treatment represent the most important factors influencing survival.
本研究报告了一名55岁糖尿病女性患者的病例，该患者患有右下肢和会阴部坏死性筋膜炎，最初因感染性休克伴心脏骤停入住急诊科，随后转至外科。微生物学和组织病理学检查确诊为由鲍曼不动杆菌引起的坏死性筋膜炎。给予了广谱抗生素治疗，并根据微生物培养结果进行了调整。需要强化血流动力学支持。伤口每天用3%硼酸溶液和磺胺嘧啶银浸渍敷料换药。立即进行了广泛的手术清创，并反复进行直至感染完全得到控制。伤口最终用中厚皮片覆盖。入院35天后感染得到控制。植皮成活率为100%。由于下肢运动功能受限，需要进行术后康复。6个月的随访显示无功能缺陷，美学效果可接受。坏死性筋膜炎是一种危及生命的疾病，尤其是在糖尿病患者中，其临床诊断有时具有挑战性。早期识别和治疗是影响生存的最重要因素。
