Department of Orhtopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan.
Trauma and Microsurgery Center, Toyohashi Municipal Hospital, Toyohashi, Japan.
Nagoya J Med Sci. 2023 Aug;85(3):619-625. doi: 10.18999/nagjms.85.3.619.
Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue infection that needs acute surgical intervention and other types of supportive care. The upper extremities are a less frequent site for this infection than the lower extremities. Axillary necrotizing fasciitis is quite rare and bears a high risk of iatrogenic neurovascular injuries. We report a severe case of a 39-year-old man with a right axillary necrotizing fasciitis caused by . While dealing with important nerves and blood vessels at the initial emergency surgery, we marked and preserved them with vascular tapes. The patient underwent several surgical interventions for infection control in addition to supportive care to avoid limb loss and to survive. Intraoperatively, the locations of nerves and vessels could be easily found by checking the vessel tapes. Twelve months after the initial admission, the patient had no symptoms of nerve injuries and resumed work. With necrotizing fasciitis, the risk of an iatrogenic nerve injury exists even if limb amputation is avoided due to repeated debridement. We report that marking and preserving nerves and blood vessels with vascular tapes at the initial surgery may make the subsequent ones easier and may reduce iatrogenic neurovascular injury.
坏死性筋膜炎是一种迅速发展、危及生命的软组织感染，需要急性手术干预和其他类型的支持性治疗。上肢比下肢较少发生这种感染。腋部坏死性筋膜炎非常罕见，但存在医源性神经血管损伤的高风险。我们报告了一例严重的 39 岁男性右侧腋部坏死性筋膜炎病例，该病例由 引起。在初次急诊手术中处理重要的神经和血管时，我们用血管带标记和保护它们。除了支持性治疗以避免肢体丧失和存活外，患者还进行了多次手术干预以控制感染。术中通过检查血管带可以轻松找到神经和血管的位置。初次入院 12 个月后，患者无神经损伤症状并恢复工作。对于坏死性筋膜炎，即使由于反复清创而避免了肢体截肢，也存在医源性神经损伤的风险。我们报告说，在初次手术时用血管带标记和保护神经和血管，可能会使后续手术更容易，并减少医源性神经血管损伤。
