Hu Jiayi, Goekjian Serge, Stone Nicolas, Nelson Alexandra, Cooper Michael James
Division of Plastic & Reconstructive Surgery, McMaster University, Hamilton, Ontario, Canada.
Faculty of Medicine, Michael G. DeGroote School of Medicine, McMaster University.
Wounds. 2017 Aug;29(8):E55-E60.
Necrotizing fasciitis (NF) is a life-threatening condition in which rapid diagnosis, debridement of nonviable tissue, and broad-spectrum antibiotics are critical to effective treatment. The debridement required can be extensive, resulting in large wounds that can sometimes be covered with split-thickness skin grafts (STSGs) with the help of negative pressure wound therapy (NPWT), or vacuum-assisted closure, to decrease the wound size.
The authors report a rare case of NF due to malignancy-associated bowel perforation with a giant lower extremity wound secondary to debridement that involved 20% of the total body surface area (TBSA) in a 64-year-old, previously healthy, nonsmoking man. The wound was surgically debrided twice and packed before NPWT was applied. Based on the authors' literature search, this case is 1 of the single largest wounds successfully managed with a STSG and NPWT.
Rapid diagnosis of NF is critical to guide surgical management and administration of antibiotics. It is important to be mindful of the origin of certain necrotizing infections, and clinicians should have a greater index of suspicion for NF when assessing skin infections in unwell patients with concomitant bowel perforation secondary to gastrointestinal malignancy.
坏死性筋膜炎（NF）是一种危及生命的疾病，快速诊断、清除坏死组织以及使用广谱抗生素对于有效治疗至关重要。所需的清创范围可能很大，会导致大面积伤口，有时可借助负压伤口治疗（NPWT）或真空辅助闭合技术，用中厚皮片移植（STSG）覆盖伤口，以缩小伤口尺寸。
作者报告了一例罕见的因恶性肿瘤相关肠穿孔导致的坏死性筋膜炎病例，一名64岁、既往健康、不吸烟的男性患者，清创后下肢出现巨大伤口，占全身表面积（TBSA）的20%。伤口进行了两次外科清创并填塞，之后应用了负压伤口治疗。根据作者的文献检索，该病例是成功通过中厚皮片移植和负压伤口治疗处理的最大伤口之一。
坏死性筋膜炎的快速诊断对于指导手术治疗和抗生素的使用至关重要。了解某些坏死性感染的起源很重要，临床医生在评估伴有胃肠道恶性肿瘤继发肠穿孔的不适患者的皮肤感染时，应提高对坏死性筋膜炎的怀疑指数。
