Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany.
Department of Anesthesia, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
Microsurgery. 2020 Nov;40(8):911-915. doi: 10.1002/micr.30673. Epub 2020 Oct 21.
We report the case of a 67-year old male with necrotizing fasciitis after injection of the glenohumeral joint. After extensive debridement a massive defect from the left hip joint to the left upper arm, exposing ribs, scapula, axillary vessels and brachial plexus (45 × 40 cm) was present. Reconstruction was performed with a conjoined right myocutaneous tensor fasciae lata/vastus lateralis flap and a left myocutaneous vastus lateralis flap in combination with an arteriovenous loop originating from the axillary vessels using the greater saphenous vein. Revisional surgeries were necessary including ribs resection and flap re-advancements. Due to multiorganic failure invasive ventilation, renal replacement- and extensive transfusion therapy was required. After 241 days the patient was discharged for rehabilitation. At the 12 months follow-up wounds were sufficiently closed without the need for further intervention. This case illustrates that immediate diagnosis followed by an aggressive multidisciplinary treatment approach is crucial for the patient survival.
我们报告了一例 67 岁男性在肩关节注射后发生坏死性筋膜炎的病例。经过广泛清创，从左髋关节到左上臂出现了一个巨大的缺损，暴露了肋骨、肩胛骨、腋窝血管和臂丛（45×40cm）。使用大隐静脉，采用右侧股外侧肌筋膜/股外侧肌联合皮瓣和左侧股外侧肌肌皮瓣，与源自腋窝血管的动静脉环进行了重建。需要进行多次修正手术，包括肋骨切除和皮瓣推进。由于多器官衰竭，需要进行有创通气、肾脏替代治疗和大量输血治疗。241 天后，患者出院接受康复治疗。12 个月随访时，伤口已充分闭合，无需进一步干预。本例说明，及时诊断并采取积极的多学科治疗方法对患者的生存至关重要。
