Minini Andrea, Galli Stefano, Salvi Andrea Giordano, Zarattini Guido
Clinica Ortopedica dell'Università degli Studi di Brescia.
Acta Biomed. 2018 Dec 14;90(1-S):162-168. doi: 10.23750/abm.v90i1-S.7992.
Necrotizing Fasciitis is a rare life-threatening infection , usually polymicrobial, that frequently affects the extremities in as many as two thirds of the cases. It typically involves primarily the muscular fascia, and then spreads through muscular and subcutaneous tissues. The early diagnosis may be challenging , and appears to be crucial in the management of this condition. We report a case of a 45-year-old man, former drug abuser, diabetic, HCV +, who developed a necrotizing fasciitis of the hand following a minor trauma. Early diagnosis based on clinical, laboratory (LRINEC score) and radiological findings, together with an accurate debridement of the affected site, allowed us to limitate the amputation to the third ray only. The reconstruction with the capitate osteotomy and the coverage with the posterior interosseous flap helped us in further reduction of the functional impairment of the hand.
坏死性筋膜炎是一种罕见的危及生命的感染，通常为多微生物感染，多达三分之二的病例常累及四肢。它通常主要累及肌肉筋膜，然后通过肌肉和皮下组织扩散。早期诊断可能具有挑战性，而这在该疾病的治疗中似乎至关重要。我们报告一例45岁男性病例，该患者曾是药物滥用者、糖尿病患者、丙型肝炎病毒阳性，在一次轻微创伤后发生手部坏死性筋膜炎。基于临床、实验室（LRINEC评分）和影像学检查结果进行早期诊断，以及对感染部位进行精确清创，使我们仅将截肢范围限制在第三掌骨。头状骨截骨术重建和骨间后动脉皮瓣覆盖有助于我们进一步减轻手部的功能障碍。
