Kawasmi Sanad H, Ajlouni Jihad, Almanaseer Qusai, Kaylani Laith, Hassan Abbas
Orthopaedics, University of Jordan, Amman, JOR.
Orthopaedics, Jordan University Hospital, Amman, JOR.
Cureus. 2020 Apr 2;12(4):e7508. doi: 10.7759/cureus.7508.
Epidermolysis bullosa (EB) is a rare dermatological disease in which patients suffer from skin fragility and blisters. One of the major complications is the development of skin infections, which may preclude surgical intervention. We present a case of a 49-year-old female with a past medical history of EB, who presented to the emergency department (ED) with right groin pain of one-hour duration after falling on her right side. The patient underwent a successful open reduction and internal fixation for her right hip without complications. Over the course of three months after the procedure, she experienced worsening of the pain accompanied by skin necrosis and total collapse of the femoral head. Subsequent total hip replacement surgery was performed using a cementless (Zimmer, Warsaw, IN) prosthesis and fixated via cannulated screws. To decrease the risk of infection, IV cefazolin was given as a prophylactic antibiotic preoperatively. Vancomycin IV and imipenem/cilastatin IV were given for four days postoperatively. We made sure that our patient is experiencing the least possible pain by giving sufficient analgesics after the surgery. We used morphine, paracetamol, and gabapentin for pain control. For 25 days after the surgery, the patient did not complain of any pain. Upon follow-up, sutures were removed, and no surgical wound infection, rashes, or lacerations were noted. We encourage orthopedic surgeons dealing with patients suffering from dermatological conditions with fragile skin such as EB and decreased level of activity that requires total hip arthroplasty to proceed with the surgical intervention after considering adequate infection control to improve quality of life.
大疱性表皮松解症（EB）是一种罕见的皮肤病，患者会出现皮肤脆弱和水疱。主要并发症之一是皮肤感染的发生，这可能会妨碍手术干预。我们报告一例49岁女性，有EB病史，因右侧摔倒后出现持续一小时的右腹股沟疼痛而就诊于急诊科。患者接受了右髋关节切开复位内固定术，手术成功，无并发症。术后三个月内，她的疼痛加重，伴有皮肤坏死和股骨头完全塌陷。随后使用非骨水泥型（Zimmer，印第安纳州华沙）假体进行了全髋关节置换手术，并通过空心螺钉固定。为降低感染风险，术前给予静脉注射头孢唑林作为预防性抗生素。术后四天给予静脉注射万古霉素和亚胺培南/西司他丁。我们通过术后给予足够的镇痛药确保患者尽可能少地感到疼痛。我们使用吗啡、对乙酰氨基酚和加巴喷丁来控制疼痛。术后25天，患者未诉任何疼痛。随访时，拆除缝线，未发现手术伤口感染、皮疹或撕裂伤。我们鼓励骨科医生在处理患有EB等皮肤脆弱的皮肤病且活动水平下降需要进行全髋关节置换术的患者时，在考虑充分的感染控制后进行手术干预，以提高生活质量。
