Fujii Masakazu, Imamura Kiyotaka, Kato Kentaro, Takada Minoru, Ambo Yoshiyasu, Nakamura Fumitaka, Hirano Satoshi
Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan; Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido, Japan.
Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
Int J Surg Case Rep. 2021 May;82:105908. doi: 10.1016/j.ijscr.2021.105908. Epub 2021 Apr 27.
Necrotizing soft tissue infection (NSTI) of the chest wall is a rare, rapidly spreading, highly lethal surgical disease. Radical debridement interferes with the important anatomical function of the chest wall. We report a case of chest wall NSTI that was successfully managed with early diagnosis and serial debridement.
A 43-year-old, previously healthy woman presented with severe malaise and worsening right axillary pain. She was severely lethargic and had a painful, large, pale lesion with surrounding erythema of the right chest and trunk. Computed tomography revealed NSTI, with diffuse soft tissue inflammation extending from the axilla to the lower abdomen. There was no obvious entry portal. Prompt surgical drainage was established. Group A streptococcus infection was diagnosed. During her 3-month postoperative course, she underwent four more surgeries, including two debridements. This treatment proved successful and avoided the need for complicated muscle flap reconstruction. She was discharged on postoperative day 109.
Group A streptococcus can cause NSTI even in immunocompetent patients without an entry portal. Radical debridement is recommended for infection control. Preserving anatomical chest wall function, however, is also important. Serial debridement with close follow-up solved the problem in this patient.
Serial debridement with close follow-up enabled to avoid large tissue deficits and complicated reconstruction in the case of NSTI of the chest wall.
胸壁坏死性软组织感染（NSTI）是一种罕见的、迅速蔓延且极具致死性的外科疾病。根治性清创会干扰胸壁的重要解剖功能。我们报告一例胸壁NSTI病例，通过早期诊断和系列清创成功治愈。
一名43岁、既往健康的女性，出现严重不适及右腋窝疼痛加重。她极度嗜睡，右侧胸部和躯干有一个疼痛的、巨大的、苍白的病变，周围伴有红斑。计算机断层扫描显示为NSTI，弥漫性软组织炎症从腋窝延伸至下腹部。无明显的感染入口。立即进行了手术引流。诊断为A组链球菌感染。在术后3个月的病程中，她又接受了4次手术，包括2次清创。这种治疗方法证明是成功的，避免了复杂的肌皮瓣重建的需要。她于术后第109天出院。
A组链球菌即使在没有感染入口的免疫功能正常的患者中也可引起NSTI。建议进行根治性清创以控制感染。然而，保留胸壁的解剖功能也很重要。在该患者中，通过系列清创并密切随访解决了问题。
对于胸壁NSTI病例，通过系列清创并密切随访能够避免大面积组织缺损和复杂的重建手术。
