Huff Mallorie L, Wilson Kyle S, Kane Kathleen E, Wheel Kathryn L, Stirparo Joseph J
Department of Surgery, Division of Trauma and Acute Care Surgery, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Bethlehem, USA.
Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Bethlehem, USA.
Cureus. 2022 Feb 21;14(2):e22438. doi: 10.7759/cureus.22438. eCollection 2022 Feb.
Necrotizing fasciitis is a life-threatening infection that can be rapidly fatal. Early identification and emergent surgical management are essential to minimize morbidity and mortality. This case report describes a 25-year-old male who presented to the emergency department with a three-day history of worsening left lower dental infection and new-onset neck pain and swelling. He received broad-spectrum antibiotics and intravenous fluid resuscitation and underwent computed tomography of the neck and chest. Following intensive care unit admission, he underwent tooth extraction where intraoperative evaluation revealed subcutaneous crepitus. Immediate debridement was performed, revealing copious foul-smelling purulent discharge and necrotic tissue extending over the anterior chest wall and neck. During his hospital course, he underwent multiple debridements to manage the expanding infection. The final tissue defect was substantial, with deep dissection to muscle extending over the entire anterior surface of the rib cage to just inferior to the clavicles. This significant tissue defect was managed with skin grafts, and he was discharged home in stable condition. The patient is doing well almost a year after discharge. The key to our patient's survival was the early identification and debridement of the affected tissue. Our study reinforces the tenants of wound care and aggressive management required to bolster patient odds of survival in the setting of necrotizing fasciitis and underscores the importance of maintaining vigilance in patients presenting with dental infections. This study is unique in that our patient was young, with a past medical history significant for polydrug use, and the area of debridement was substantial.
坏死性筋膜炎是一种危及生命的感染，可迅速致命。早期识别和紧急手术处理对于将发病率和死亡率降至最低至关重要。本病例报告描述了一名25岁男性，他因左下牙感染加重伴新发颈部疼痛和肿胀3天就诊于急诊科。他接受了广谱抗生素治疗和静脉补液复苏，并进行了颈部和胸部的计算机断层扫描。入住重症监护病房后，他接受了拔牙手术，术中评估发现皮下气肿。立即进行了清创，发现有大量恶臭脓性分泌物和坏死组织，延伸至前胸壁和颈部。在住院期间，他接受了多次清创以控制不断扩大的感染。最终的组织缺损很大，深部解剖至肌肉，延伸至整个胸廓前表面直至锁骨下方。通过植皮处理了这一严重的组织缺损，他出院时情况稳定。出院近一年后，患者情况良好。我们患者存活的关键是早期识别并清创受影响的组织。我们的研究强化了伤口护理的原则以及在坏死性筋膜炎情况下提高患者生存几率所需的积极处理，并强调了对有牙感染的患者保持警惕的重要性。本研究的独特之处在于我们的患者很年轻，有大量使用多种药物的病史，且清创面积很大。
