Gallagher Kathy, Desai Harsh K, Alberto Emily C, Cardenas Luis
Acute Surgical Wound Service, Christiana Care Health System. Newark, Delaware.
Surgical Critical Care, Christiana Care Health System. Newark, Delaware.
Wound Manag Prev. 2022 Jan;68(1):16-21.
Necrotizing soft tissue infection (NSTI) is rare and characterized by rapid onset and spread of inflammation and necrosis. The infection starts within the fascia but can rapidly progress to include musculature, subcutaneous fat, and overlying skin. Its presentation is considered a surgical emergency. Persons who use intravenous or subcutaneous opioids are at higher risk of NSTIs.
The purpose of this case report is to describe the positive clinical outcome after consulting with wound specialists and using a dressing regimen to expedite more rapid wound healing, shortened time to skin graft, and improved pain tolerance in a patient with a history of intravenous and subcutaneous heroin use.
The patient presented with an NSTI that required extensive debridement of the bilateral upper extremities. The acute surgical wound service was consulted. A dressing regimen consisting of hypochlorous acid-preserved wound cleansing, followed by carboxymethylcellulose fiber with 1.2% ionic silver covered by hydrocellular foam to promote a moist healing environment, was used to facilitate granulation.
Healthy granulation tissue was noted 6 days after debridement. The improved rate of granulation and the patient's tolerance to dressing changes secondary to decreased pain from these dressings significantly expedited the time to graft and wound healing. The patient underwent split-thickness skin grafting 10 days after debridement. There was 100% uptake of the grafts on postgraft day 8.
The favorable clinical outcome suggests that early consultation with wound specialists and implementation of the dressing regimen were effective in this patient regarding improved pain control and healing. However, because the patient left against medical advice on hospital day 20, the clinical course could not be followed beyond the first few postoperative weeks.
坏死性软组织感染（NSTI）较为罕见，其特点是炎症和坏死迅速发作并扩散。感染始于筋膜内，但可迅速蔓延至肌肉组织、皮下脂肪和覆盖的皮肤。其表现被视为外科急症。使用静脉或皮下注射阿片类药物的人患NSTI的风险更高。
本病例报告的目的是描述一名有静脉和皮下注射海洛因病史的患者，在咨询伤口专家并采用敷料方案后，获得了积极的临床结果，该方案加快了伤口愈合速度、缩短了进行皮肤移植的时间并提高了疼痛耐受性。
该患者出现NSTI，需要对双侧上肢进行广泛清创。咨询了急性外科伤口服务团队。采用了一种敷料方案，先用次氯酸进行伤口清洁，然后用含1.2%离子银的羧甲基纤维素纤维，再覆盖水凝胶泡沫以促进湿润的愈合环境，以促进肉芽组织生长。
清创后6天可见健康的肉芽组织。肉芽组织生长速度加快，且由于这些敷料减轻了疼痛，患者对换药的耐受性增强，显著加快了移植和伤口愈合的时间。患者在清创后10天接受了中厚皮片移植。移植后第8天移植皮片的成活率为100%。
良好的临床结果表明，早期咨询伤口专家并实施敷料方案对该患者在改善疼痛控制和促进愈合方面是有效的。然而，由于患者在住院第20天违反医嘱自行离开，术后最初几周后的临床病程无法追踪。
