NECROTIZING FASCIITIS OF THE UPPER LEG – CASE REPORT AND REVIEW OF THE LITERATURE

Autori:

Krešimir Martić, Željko Bušić, Srećko Budi, Vlatka Čavka, Mislav Čavka

Sažetak

Sažetak. Nekrotizirajući fascitis je rijetka, ali vrlo teška infekcija kože, potkožnog tkiva i fascije, karakterizirana izrazito brzim širenjem upale. Povezana je sa značajnim morbiditetom i mortalitetom. Četrdesetdvogodišnji muškarac primljen je u Kliniku za kirurgiju preko Hitne kirurške službe, zbog nekrotizirajućeg fascitisa desne natkoljenice. Višekratno je učinjen kirurški debridman zahvaćene regije uz intravensku primjenu antibiotika i mjere intenzivnog liječenja. Zbog septičkog šoka s početnim stadijem multiorganskog zatajenja bolesnik je tjedan dana liječen u jedinici intenzivnog liječenja (JIL). Defekt kože, zaostao nakon učinjenih nekrektomija, rekonstruiran je kožnim transplantatom djelomične debljine kože, četvrti dan nakon prijma u bolnicu. Bolesnik je otpušten na kućnu njegu dvadeset prvi dan nakon primitka u bolnicu. Nekrotizirajući fascitis je bolest opasna za život koja zahtijeva brzu dijagnozu, hitnu opsežnu kiruršku eksciziju nekrotičnog tkiva i rekonstrukciju nastalog defekta što ranije radi prevencije sekundarnih infekcija. Mjere intenzivnog liječenja i intravenska primjena antibiotika gotovo uvijek su potrebni u liječenju bolesti.

Summary

Summary. Necrotizing fasciitis is an uncommon but serious infection of skin, subcutaneous fat and fascia, characterised by rapidly spreading inflammation and associated with considerable morbidity and mortality. A 42-year-old man, with ne¬crotizing fasciitis of the right upper leg, was hospitalized and treated by surgical debridement, along with intravenous administration of antibiotics, fluid resuscitation, correction of acidosis and electrolyte abnormalities. Four debridements were performed over four days. The patient developed septic shock with early stage of multiple organ failure, requiring one week in intensive care unit (ICU). Split-thickness skin grafts were placed on the fourth day after admission to the hospital. The patient was released to home care on the 21st day after admission, fully recovered. Necrotizing fasciitis is a life threatening infectious entity that requires rapid diagnosis, urgent extensive surgical debridement and tissue coverage as soon as possible to prevent secondary infections. ICU measures including intravenous antibiotics are often necessary, along with surgical treatment.