Joomun Muhammad Umar, Li Zhiya, Xue Deting, Shao Huawei, Pan Zhijun
Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province.
Department of Emergency, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province.
Medicine (Baltimore). 2020 Jun 26;99(26):e20874. doi: 10.1097/MD.0000000000020874.
Idiopathic necrotizing fasciitis (NF) is an infrequent, highly lethal skin infection that spreads rapidly, marked by fascia and subcutaneous tissue necrosis. It occurs in the absence of a known causative factor. Its emergence after sterile orthopedic fixation with unexpected spread to the abdomen may turn to be challenging both as a medical and surgical emergency.
A 56-year-old diabetic female presented with multiple fractures. After open reduction and internal fixation (ORIF) with iliac crest grafting of hip fracture, she developed incisional NF which later spread to the abdomen.
Post-ORIF of hip fracture complicated with idiopathic NF and abdominal spread.
She underwent emergency débridements with negative pressure wound therapy and broad-spectrum intravenous antibiotic therapy. After granulation, the wounds were closed with skin flaps and grafts with antibiotic beads. When the NF spread to the abdomen, additional débridements during abdominal explorations were performed.
The patient was initially stable with promising healings of the wounds. Later, the patient suddenly developed a high fever and severe abdominal pain. Ultrasound revealed that NF emerged unexpectedly in the right lower abdomen. The causative agent of the NF remained undetected. Despite all the extensive treatments, the patient's condition deteriorated rapidly. She died of septic shock and multiple organ failure.
The idiopathic NF may still potentially occur after a clean ORIF of the hip region. The implementation of intensive guideline-based treatments may show improvements, but the risk of unexpected NF spread to the abdomen should be anticipated, which may increase the mortality rates in diabetic or immunocompromised patients.
特发性坏死性筋膜炎（NF）是一种罕见但致死率极高的皮肤感染，其蔓延迅速，以筋膜和皮下组织坏死为特征。它在没有已知致病因素的情况下发生。在无菌骨科固定后出现并意外蔓延至腹部，这在医疗和外科急症方面都可能极具挑战性。
一名56岁的糖尿病女性患者因多处骨折就诊。在对髋部骨折进行切开复位内固定（ORIF）并取自体髂骨植骨后，她发生了切口处的NF，随后蔓延至腹部。
髋部骨折ORIF术后并发特发性NF并蔓延至腹部。
她接受了紧急清创术、负压伤口治疗以及广谱静脉抗生素治疗。伤口出现肉芽组织后，采用皮瓣和带抗生素珠的移植物进行伤口闭合。当NF蔓延至腹部时，在腹部探查期间进行了额外的清创术。
患者最初情况稳定，伤口愈合前景良好。后来，患者突然出现高热和严重腹痛。超声检查显示右下腹意外出现NF。NF的病原体仍未查明。尽管进行了所有广泛的治疗，但患者病情迅速恶化。她死于感染性休克和多器官功能衰竭。
在髋部进行清洁的ORIF术后仍可能发生特发性NF。实施基于指南的强化治疗可能会有所改善，但应预见到NF意外蔓延至腹部的风险，这可能会增加糖尿病或免疫功能低下患者的死亡率。
