Tsuge Itaru, Matsui Miho, Takeda Takuma, Yamanaka Hiroki, Katsube Motoki, Sakamoto Michiharu, Morimoto Naoki
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Dermatology, Ijinkai Takeda General Hospital, Kyoto, Japan.
Plast Reconstr Surg Glob Open. 2021 Sep 13;9(9):e3793. doi: 10.1097/GOX.0000000000003793. eCollection 2021 Sep.
Patients with severe group A Streptococcus (GAS) induced necrotizing soft tissue infection sometimes develop Streptococcal toxic shock syndrome, which is a life-threatening condition with an extremely high fatality rate. Obtaining survival is the most important goal; however, an early diagnosis for debridement surgery and quick granulation formation for skin grafting surgery can better preserve the extremity functions. The patient was a 47-year-old man with a history of atopic dermatitis who presented with GAS-induced necrotizing soft tissue infection in his left lower extremity. His vital signs indicated shock, and he was diagnosed with streptococcal toxic shock syndrome. Emergency surgery was performed with his body pressure maintained with noradrenaline. Intraoperatively, rapid antigen detection tests (RADTs) were negative in the medial thigh and positive in the lower leg, which helped in decision-making regarding the area of aggressive debridement surgery. The wound culture results matched the intraoperative rapid antigen detection test results. A collagen/gelatin sponge with the sustained release of basic fibroblast growth factor was used as an artificial dermis before skin grafting. Excellent granulation was obtained, and skin grafting surgery was performed on the 11th day after collagen/gelatin sponge placement. He was discharged home on the 42nd day with normal lower extremity functions. First, an intraoperative diagnosis using GAS-rapid antigen detection tests with an appropriate sampling method from small incisions avoided excessive surgical debridement. Second, collagen/gelatin sponge with the sustained release of basic fibroblast growth factor promoted quick granulation tissue formation for wound bed preparation. These efforts resulted in the successful less-invasive treatment of a patient with streptococcal toxic shock syndrome caused by GAS-induced necrotizing soft tissue infection.
患有严重 A 组链球菌（GAS）引起的坏死性软组织感染的患者有时会发展为链球菌中毒性休克综合征，这是一种危及生命的疾病，死亡率极高。获得生存是最重要的目标；然而，早期诊断以进行清创手术以及快速形成肉芽组织以进行皮肤移植手术可以更好地保留肢体功能。该患者是一名 47 岁男性，有特应性皮炎病史，左下肢出现 GAS 引起的坏死性软组织感染。他的生命体征显示休克，被诊断为链球菌中毒性休克综合征。在使用去甲肾上腺素维持其身体血压的情况下进行了急诊手术。术中，大腿内侧的快速抗原检测试验（RADTs）为阴性，小腿为阳性，这有助于就积极清创手术的区域做出决策。伤口培养结果与术中快速抗原检测试验结果相符。在皮肤移植前，使用了一种可持续释放碱性成纤维细胞生长因子的胶原蛋白/明胶海绵作为人工真皮。获得了良好的肉芽组织，并在放置胶原蛋白/明胶海绵后的第 11 天进行了皮肤移植手术。他在第 42 天出院，下肢功能正常。首先，使用 GAS 快速抗原检测试验并从小切口采用适当的采样方法进行术中诊断，避免了过度的手术清创。其次，可持续释放碱性成纤维细胞生长因子的胶原蛋白/明胶海绵促进了伤口床准备的快速肉芽组织形成。这些努力成功地对一名由 GAS 引起的坏死性软组织感染导致的链球菌中毒性休克综合征患者进行了微创治疗。
