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25 cases clinical analysis of necrotizing fasciitis


The necrotic tissue is. Secretions for bacterial culture and sensitivity test. Combined with high dose of early application of effective antibiotics, supportive therapy to strengthen, supplement electrolytes, vitamins, correct acidosis. 18 cases due to a larger wound, infection control,[link widoczny dla zalogowanych], wound fresh wounds after skin grafting elimination; 2 cases of small wounds, the release subcutaneous tissue, wound closure; 5 cases diagnosed in time, patients with septic shock can not be corrected, with sepsis, renal failure, died. 2 discussion necrotizing fasciitis is a clinically rare to widespread and rapid skin, subcutaneous tissue and fascia characterized by necrosis of soft tissue infections, often accompanied by systemic symptoms of poisoning. 2.1 Early diagnosis of this disease with severe systemic symptoms, local signs,[link widoczny dla zalogowanych], but not significant, so the diagnosis is often difficult, and thus delay in treatment, leaving the high mortality rate, up to 30% C1], so early diagnosis essential. Where small wounds after a large area of ​​skin irritation, systemic symptoms weight, poor resistance to infection treatment, should think of the possibility of the disease J. Similar to the performance of early cellulitis. Fever, swelling of affected area, pain, skin temperature high, high white blood cells,[link widoczny dla zalogowanych], the rapid development and rapid spread can occur 1 week renal failure, sepsis. 15 patients in this group had diagnosed cellulitis, 2 patients diagnosed erysipelas. The antibiotic treatment was not obvious, at this time desirable subcutaneous exudate for bacterial culture, such as a mixed infection of aerobic and anaerobic bacteria can be confirmed. Bacteriological examination in the diagnosis of particular importance, especially in wound pus smears. The patients were diagnosed by bacterial culture. 2.2 Treatment of surgical debridement without delay is the most important treatment of this disease measures, early incision and drainage, multi-incision, large incision,[link widoczny dla zalogowanych], complete removal of all necrotic tissue, till we see the appearance of the normal tissue, the disease not involving the muscle . Become gray and muscle fascia that has been separated from their necrosis, necrosis was still tough early, late, such as cotton, do not cut off not falling. Space for muscle fascia tissue necrosis of the deep, important in avoiding damage blood vessels, nerves, based on available hemostat clamp sneak out and cut skin edges probe. Creeping necrotic tissue of the skin excision should be selective, because the latter may be recovered after an important way to thick flap. Fully open wound drainage, with plenty of hydrogen peroxide or potassium permanganate and metronidazole rinse the wound tissue increased redox potential difference, resulting in conditions not conducive to propagation of anaerobic bacteria to control the infection continues to spread and spread. Dressing accelerate the necrotic tissue back surgery off, dressing should be repeated bacterial culture to the early detection of secondary bacteria. Fresh wound, the skin graft wound closure. Early high-dose combination of effective antibiotics, the bacterial culture and sensitivity results are not clear, should take into account the possibility of a variety of bacteria, as application of broad-spectrum antibiotics to cephalosporins III, IV on behalf of the appropriate. Drug susceptibility results are clearly defined, adjusted antibiotics. In the anti-shock, anti-infection, based on strengthening symptomatic and supportive therapy, added high protein, high calorie diet, a small amount of repeated blood transfusion, plasma, albumin, added electrolytes, vitamins, to correct acidosis. China had a debridement,[link widoczny dla zalogowanych], skin grafting immediately success stories-3J. But I think that because of a difficult debridement, necrotic tissue may further the development of skin graft success rate was significantly reduced. Should be in stable condition, the skin graft is better wound closure. Gozal and Shunak total of 47 cases of the disease were treated with adjuvant hyperbaric oxygen (HBO) treatment, and were compared, the result of hyperbaric oxygen on the disease showed no benefit and does not reduce mortality and morbidity. In conclusion, early diagnosis and treatment are key to the disease. This group of cases, 5 cases treated early to late or doctor consultation time lack of knowledge about the disease, delay in treatment time, man-made extension of its duration, and even death, this is the lessons learned. [
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