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负压伤口治疗成功治愈坏死性筋膜炎的病例报告

A case report of successful treatment of necrotizing fasciitis using negative pressure wound therapy.

作者信息

de Paula Fabiana Martins, Pinheiro Edivania Anacleto, Oliveira Vanessa Marcon de, Ferreira Cristiane Munaretto, Monreal Maria Tereza Ferreira Duenhas, Rolan Marisa Dias, Matos Vanessa Terezinha Gubert de

机构信息

Residência Multiprofissional em Cuidados Continuados Integrados.

Hospital São Julião.

出版信息

Medicine (Baltimore). 2019 Jan;98(2):e13283. doi: 10.1097/MD.0000000000013283.

Abstract

RATIONALE

Necrotizing fasciitis is a destructive tissue infection with rapid progression and high mortality. Thus, it is necessary that high-performance dressings be introduced as possibilities of treatment.

PATIENT CONCERNS

Female patient, 44 years of age, admitted to hospital unit complaining of lesion in the gluteal region and drainage of purulent secretion in large quantity followed by necrosis.

DIAGNOSES

The diagnosis of necrotizing fasciitis was carried out with the computerized tomography examination result and its association with the patient's clinical condition.

INTERVENTIONS

Initially, successive debridements were carried out in lower limbs as well as primary dressing with enzymatic debriding action until indication of negative pressure wound therapy, for the period of 2 weeks in the right lower limb and for 5 weeks in the left lower limb, with changes every 72 h. Dressing with saline gauze was used at the end of this therapy until hospital discharge.

OUTCOMES

After the use of negative pressure wound therapy, we observed the presence of granulation tissue, superficialization and reduction of lesion extension. The patient presented good tolerance and absence of complications.

LESSONS

Negative pressure wound therapy constituted a good option for the treatment of necrotizing fasciitis, despite the scarcity of protocols published on the subject.

摘要

理论依据

坏死性筋膜炎是一种具有快速进展和高死亡率的破坏性组织感染。因此,引入高性能敷料作为治疗的可能性是必要的。

患者情况

44岁女性患者,因臀区病变及大量脓性分泌物引流伴坏死入院。

诊断

根据计算机断层扫描检查结果及其与患者临床状况的关联做出坏死性筋膜炎的诊断。

干预措施

最初,对下肢进行连续清创,并使用具有酶促清创作用的初级敷料,直至指示进行负压伤口治疗,右下肢为期2周,左下肢为期5周,每72小时更换一次。在该治疗结束后使用盐水纱布敷料直至出院。

结果

使用负压伤口治疗后,我们观察到有肉芽组织形成、病变浅表化和范围缩小。患者耐受性良好且无并发症。

经验教训

尽管关于该主题发表的方案较少,但负压伤口治疗是治疗坏死性筋膜炎的一个好选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc10/6336608/2836d84dc3df/medi-98-e13283-g001.jpg

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