Yokoyama Ai, Takase Chikara
Department of Plastic and Reconstructive Surgery, Yokosuka General Hospital Uwamachi, Yokosuka, JPN.
Cureus. 2021 Nov 8;13(11):e19382. doi: 10.7759/cureus.19382. eCollection 2021 Nov.
Background Necrotizing soft tissue infection (NSTI) is a rare, severe bacterial infection that causes rapidly progressive soft tissue necrosis from the skin to the muscle. The gold standard for treating NSTI is a prompt diagnosis, early surgical debridement of necrotic tissue, and antimicrobial therapy. This study investigated the relationship between the involvement of plastic surgeons and the clinical course of NSTI cases treated at Yokosuka General Hospital Uwamachi. Methodology This study involved 28 patients with NSTI who were treated at Yokosuka General Hospital Uwamachi. Patient background, outcomes (mortality and amputation), and days to the first surgery were compared in the early and nonearly plastic surgery intervention groups. Moreover, the duration of treatment was also compared in surviving patients. Differences between the two groups were analyzed using Fisher's direct probability test, Mann-Whitney U test was used for comparison of continuous variables between the two groups, and Spearman's rank correlation analysis was used for the bivariate correlation coefficient. The significance level was set at <5%. Results There were eight and 20 patients in the early and nonearly plastic surgery intervention groups (14 in later intervention and six in nonintervention), respectively. A difference in the median number of days to the first surgery between the early (zero days) and the nonearly (two days) intervention groups was significant (p = 0.002). In the survival groups, the median treatment duration in the early (n = 8) and nonearly (n = 13) intervention groups was 44 and 82 days, respectively, which was significantly shorter in the early intervention group (p = 0.003). Conclusions The number of days until the first surgery and the length of the treatment period were significantly shorter in the early plastic surgery intervention group than in the nonearly intervention group.
背景 坏死性软组织感染（NSTI）是一种罕见的严重细菌感染，可导致从皮肤到肌肉的快速进行性软组织坏死。治疗NSTI的金标准是及时诊断、早期手术清创坏死组织以及抗菌治疗。本研究调查了横须贺综合医院宇摩町分院参与治疗的整形外科医生与NSTI病例临床病程之间的关系。方法 本研究纳入了在横须贺综合医院宇摩町分院接受治疗的28例NSTI患者。比较了早期和非早期整形外科手术干预组的患者背景、结局（死亡率和截肢率）以及首次手术天数。此外，还比较了存活患者的治疗时长。两组间的差异采用Fisher直接概率检验进行分析，两组间连续变量的比较采用Mann-Whitney U检验，双变量相关系数采用Spearman秩相关分析。显著性水平设定为<5%。结果 早期和非早期整形外科手术干预组分别有8例和20例患者（后期干预组14例，非干预组6例）。早期（0天）和非早期（2天）干预组首次手术天数的中位数差异具有显著性（p = 0.002）。在存活组中，早期（n = 8）和非早期（n = 13）干预组的中位治疗时长分别为44天和82天，早期干预组明显更短（p = 0.003）。结论 早期整形外科手术干预组直到首次手术的天数和治疗周期长度均显著短于非早期干预组。
