Persano Giorgio, Pinzauti Enrico, Pancani Simone, Incerti Filippo
Department of Pediatric Surgery, Meyer Children Hospital, Florence, Italy.
Pediatric Burn Center, Meyer Children Hospital, Florence, Italy.
Plast Reconstr Surg Glob Open. 2018 Oct 3;6(10):e1953. doi: 10.1097/GOX.0000000000001953. eCollection 2018 Oct.
Ecthyma Gangrenosum is a manifestation of infection, usually occurring in immunocompromised patients, which can be associated with bacteremia with potentially lethal outcome. The clinical appearance is of an inflammatory cutaneous lesion with a central necrotic spot; the lesion then rapidly progresses to a gangrenous ulcer with a gray-black eschar extending in the deep soft tissues. Treatment of Ecthyma Gangrenosum includes both aggressive systemic antibiotic therapy and surgical procedures. A 2-year-old girl affected by B-cell precursor acute lymphoblastic leukemia was admitted to our hospital for suspected sepsis; the diagnosis was later confirmed by blood cultures positive for . In the days following the diagnosis, the patient developed a necrotic lesion of the right gluteal area consistent with Ecthyma Gangrenosum. Aggressive surgical debridement was then performed, followed by negative-pressure wound therapy and reconstruction with dermal substitute and autologous skin graft, which were successful. Ecthyma Gangrenosum is a potentially lethal condition affecting especially immunocompromised patients; aggressive medical treatment with combination antibiotic therapy is warranted and multiple surgical procedures, including extensive surgical debridement and diverting colostomy, are needed. Various reconstructive techniques have been reported in the literature, although no gold-standard can be established to date. Since Ecthyma Gangrenosum lesions are characterized by the presence of both high inflammatory activity due Pseudomonas infection and extensive tissue loss, the association of negative-pressure therapy and dermal substitutes implant seem to have a rationale in the surgical treatment of Ecthyma Gangrenosum and should therefore be considered.
坏疽性脓皮病是一种感染表现，通常发生在免疫功能低下的患者中，可能与菌血症相关，具有潜在致命后果。其临床表现为具有中央坏死斑的炎性皮肤病变；随后病变迅速发展为坏疽性溃疡，伴有延伸至深部软组织的灰黑色焦痂。坏疽性脓皮病的治疗包括积极的全身抗生素治疗和外科手术。一名患有B细胞前体急性淋巴细胞白血病的2岁女孩因疑似败血症入住我院；后来血培养证实了诊断。诊断后的几天里，患者右侧臀部出现了与坏疽性脓皮病一致的坏死病变。随后进行了积极的手术清创，接着进行负压伤口治疗，并使用真皮替代物和自体皮肤移植进行重建，均获成功。坏疽性脓皮病是一种潜在致命疾病，尤其影响免疫功能低下的患者；需要进行联合抗生素治疗的积极药物治疗，并且需要多次外科手术，包括广泛的手术清创和造口术。文献中报道了各种重建技术，尽管迄今为止尚无金标准。由于坏疽性脓皮病病变的特点是存在由铜绿假单胞菌感染引起的高炎症活性和广泛的组织损失，负压治疗和真皮替代物植入的联合似乎在坏疽性脓皮病的外科治疗中有理论依据，因此应予以考虑。
