Browne Donald T, Aguilo-Seara Gabriela, DeFranzo Anthony
Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Winston-Salem, USA.
Cureus. 2020 Nov 28;12(11):e11758. doi: 10.7759/cureus.11758.
We present the case of a 48-year-old male who developed tissue necrosis and subsequent necrotizing fasciitis in his right upper extremity after sustaining a puncture injury from a large black locust tree () splinter. Blood and intraoperative wound cultures revealed and infection. The treatment consisted of IV antibiotics, fasciotomy, and multiple debridements, which left a 30 x 5-cm defect, requiring negative pressure wound therapy with Integra Dermal Regeneration Template (Integra Lifesciences, Plainsboro Township, NJ) and, ultimately, split-thickness skin grafts. Although uncommon, plastic surgeons should be aware of tissue necrosis associated with robin toxalbumin in cases of black locust tree puncture wounds. Robin toxalbumin causes cellular death by inhibiting protein synthesis. In this patient, the toxalbumin from the black locust tree fragment led to extensive tissue necrosis, serving as the nidus for necrotizing fasciitis.
我们报告了一例48岁男性病例，该患者在被一棵大刺槐（）木片刺伤后，右上肢出现组织坏死，随后发展为坏死性筋膜炎。血液和术中伤口培养显示感染。治疗包括静脉注射抗生素、筋膜切开术和多次清创术，清创后留下一个30×5厘米的缺损，需要使用Integra真皮再生模板（Integra Lifesciences，新泽西州普林斯顿镇）进行负压伤口治疗，最终还需要进行中厚皮片移植。虽然不常见，但整形外科医生在处理刺槐刺伤导致的组织坏死病例时，应注意与刺槐毒白蛋白相关的组织坏死情况。刺槐毒白蛋白通过抑制蛋白质合成导致细胞死亡。在该患者中，刺槐碎片中的毒白蛋白导致了广泛的组织坏死，成为坏死性筋膜炎的病灶。
