Boey Johnson, Yu Longbiao, Hui Zeng, Meng Fanbin, Wan Shengxiang, Xiao Yingfeng, Zhegang Zhou
From Dr Foot Podiatry, Singapore, Singapore.
Hand and Microsurgery Department, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China.
Plast Reconstr Surg Glob Open. 2023 Aug 15;11(8):e5207. doi: 10.1097/GOX.0000000000005207. eCollection 2023 Aug.
Necrotizing soft tissue infection (NSTI) is a complex infection known for its rapid progression of necrosis within the subcutaneous tissue and fascia. Time is of essence for the management of NSTI. In this report, we present a case of NSTI after infection of poorly managed diabetic foot ulcer in the ankle. The limb salvage approach involves sequential staged procedures. Multiple surgical debridements and "washout" were performed for source control. At the same time, the patient also received a systemic antibiotic regimen. In the second stage, a perforator free flap taken from the anterolateral thigh was used to repair the extensive soft tissue defect and reconstruct a functional foot to achieve maximal limb salvage. The kickstand technique of external fixation was used to reduce soft tissue compression and enhance the surgical offloading of the skin flap. At the 2-year follow-up, the skin integrity of the flap was well-preserved, and the patient returned to his premorbid quality of life.
坏死性软组织感染（NSTI）是一种复杂的感染，以皮下组织和筋膜内坏死的快速进展为特征。对于NSTI的治疗，时间至关重要。在本报告中，我们呈现了一例因踝关节处管理不善的糖尿病足溃疡感染后发生NSTI的病例。肢体挽救方法包括序贯分期手术。为了控制感染源，进行了多次外科清创和“冲洗”。同时，患者还接受了全身性抗生素治疗方案。在第二阶段，采用取自大腿前外侧的穿支游离皮瓣修复广泛的软组织缺损并重建功能性足部，以实现最大程度的肢体挽救。使用外固定的支架技术来减轻软组织压迫并增强皮瓣的手术减负。在2年的随访中，皮瓣的皮肤完整性得到良好保存，患者恢复到病前的生活质量。
