Piczon O Y, Manahan F J, Udomsak P, Villasin J J, Clark M G
Ostomy Wound Manage. 1995 Jan-Feb;41(1):48-50, 52, 54 passim.
This case study describes an atypical case of refractory, sodium warfarin-induced necrotizing fasciitis and myonecrosis. This patient did not initially receive surgical debridement and systemic antibiotics, the standard treatment for necrotizing fasciitis of bacterial origin. This patient's wound care regimen began with silver sulfadiazine and wet-to-dry dressings, modified to initial cleansing with a zinc-saline solution, followed with application of a zinc-saline wet dressing, impregnated with an aluminum hydroxide ointment. The patient experienced pain relief after the first application. After 4 weeks, the necrotic tissue sloughed off, the early signs of healing appeared making surgical debridement possible. Therapy with the zinc-saline dressings was continued and restoration of all tissues was documented within 225 days. If aggressive surgical therapy is not an option, the prevention of secondary complications such as infection becomes the goal of treatment until the necrotic process stops and healing begins. For this goal, a moist environment may be the optimal choice for topical therapy.
本病例研究描述了一例由华法林钠引起的难治性坏死性筋膜炎和肌坏死的非典型病例。该患者最初未接受外科清创术和全身抗生素治疗，而这是细菌性坏死性筋膜炎的标准治疗方法。该患者的伤口护理方案最初采用磺胺嘧啶银和湿-干敷料，后改为先用锌盐水溶液进行初步清洁，接着使用浸渍有氢氧化铝软膏的锌盐水湿敷料。首次使用后患者疼痛缓解。4周后，坏死组织脱落，出现早期愈合迹象，使得外科清创术成为可能。继续使用锌盐水敷料进行治疗，并记录在225天内所有组织均得以恢复。如果无法选择积极的手术治疗，那么在坏死过程停止且开始愈合之前，预防感染等继发性并发症就成为治疗的目标。为实现这一目标，湿润的环境可能是局部治疗的最佳选择。
