急性坏死性筋膜炎的诊断与治疗

目的 探讨急性坏死性筋膜炎的诊断与治疗方法。方法 回顾分析5例坏死性筋膜炎病人的诊治经过。结果 5例病人3例经过穿刺确诊及时行广泛切开引流获痊愈,2例未能及时明确诊断,未行广泛切开引流而死亡。结论 局部穿刺检查对确立诊断有重要帮助,早期行广泛切开引流是治疗成功的关键。     

坏死性筋膜炎的诊断与治疗

目的 探讨坏死性筋膜炎的诊断治疗。方法 回顾性分析７例坏死性盘膜炎患者的临床资料。结果 男５例,女２例。平均年龄４５．７（８～６９）岁。７例经及时广泛切开清创引流术,有效抗菌素及支持治疗,均获痊愈。结论 提高对本病的认识,早期诊断,及时手术,加强围手术期的综合治疗是提高坏死性筋膜炎治愈率的关键。     

急性坏死性筋膜炎的早期诊断与治疗

急性坏死性筋膜炎是一种临床少见的坏死性软组织感染 ,其发病急、进展快、全身反应重 ,如不及时诊断治疗 ,常危及生命。笔者自 1990年以来诊疗 6例 ,总结如下。1　材料与方法1 1　病例资料　本组 6例 ,男 5例 ,女 1例 ,年龄 2 1～ 6 7岁。发病诱因 :皮肤挫裂伤 3例 ,下腹部术后 2例 ,无明显诱因1例。感染部位 :上臂和前臂 1例 ,手和前臂 1例 ,腹部 1例 ,下腹部、髋部、大腿和小腿 1例 ,大腿和小腿 1例 ,小腿和足部 1例。术前外院延误诊治 3例。1 2 　临床表现　均于外伤或术后 3～ 4d发病 ,局部肿胀、发红 ,疼痛不明显 ,起水泡 ,有血性渗液 …     

坏死性筋膜炎的诊治现状

坏死性筋膜炎(necrotizing fasciitis,NF)是由多种细菌入侵皮下组织和筋膜引起的坏死性软组织感染,临床上较为少见,常伴有全身中毒性休克.如不及时诊断和治疗,患者往往死于败血症、毒血症和多器官功能衰竭.尽管近年来广谱抗生素不断问世,细菌培养及敏感实验技术有明显改进,但NF的死亡率仍居高不下.因此,提高对本病的认识具有重要的临床意义.现将本病的诊治现状综述如下.     

会阴部坏死性筋膜炎的研究现状

会阴部坏死性筋膜炎是一种罕见的并可能致命的软组织感染。感染发展迅速,很快就可能进展为感染性休克。当合并糖尿病、免疫抑制、慢性酒精疾病、慢性肾衰竭、肝硬化时预后相对较差。感染通常由多种细菌协同作用导致,尽管目前广谱抗生素不断问世,细菌培养及敏感实验技术明显改进,但死亡率仍很高(平均死亡率32.2%)。因此,早期对会阴部坏死性筋膜炎的诊断和治疗至关重要。该文就其发病率、风险因素、致病细菌、临床表现、诊断治疗等加以介绍。     

四肢坏死性筋膜炎的诊断与治疗

目的：探讨四肢坏死性筋膜炎的早期诊断与治疗方法。方法：2000年1月—2008年1月间收治11例四肢坏死性筋膜炎患者,男8例,女3例;平均年龄32.9岁。所有患者予以急诊清创、抗感染、对症支持治疗,后期行康复锻炼。结果：11例患者均获治愈且肢体功能恢复良好,住院时间27～61d,平均43d。结论：对四肢坏死性筋膜炎进行早期诊断、彻底清创、合理用药、积极支持治疗与及时康复锻炼,能取得较好的治疗效果。     

急性坏死性筋膜炎的综合治疗

目的：探讨急性坏死性筋膜炎的综合治疗。方法：回顾2003年7月～2013年7月我院收治的7例急性坏死性筋膜炎患者的,临床特点及综合治疗临床资料进行分析。结果：7例患者均治愈,经过1月～3年的随访,患者愈合后功能恢复良好,生活均能自理,部分患者恢复劳动能力。结论：明确诊断及时切开减压,扩大清创引流,必要时反复清创,延期修复创面并结合全身支持的综合治疗是治疗急性坏死性筋膜炎的关键。     

会阴部坏死性筋膜炎的治疗——附6例报告

坏死性筋膜炎,系一种少见的以侵犯筋膜为主,并累及皮肤、皮下组织但无肌坏死的坏死性软组织感染,具有起病急、发展迅速、病情凶险、病死率高等特点。笔者自1988年至今共收治了6例会阴部坏死性筋膜炎,采用中西医结合方法,取得满意疗效,现介绍如下。1　临床资料本组均为男性。年龄最小者31岁,最大者72岁。病史最短者为4ｄ,最长者为2周。起病急,均有恶寒、发热(38℃～396℃)等全身症状。局部麻木,红、肿、热、痛均较明显,且迅速向周围扩展,局部可见黑色病变。红肿仅限于肛门周围的2例,其余4例,均累及阴囊部位,局部可闻及捻发音4例。血糖偏高者3…     

坏死性筋膜炎的诊治

坏死性筋膜炎的诊治值得进一步探讨。现将我院11例的诊治经验报告如下：     

坏死性筋膜炎的诊治

目的：探讨坏死性筋膜炎的诊治方法。方法：回顾性分析24例患者的临床资料。结果：男20例，女4例，平均年龄55岁，病变范围从局限于会阴部至从腰，臂部及左下肢，21例细菌培养 阳性，其中11例为混合感染，23例术前诊断,，经采用手术为主的综合疗法治疗，21例治愈，2例死亡，1例误诊为腹膜炎，术后自动出院，结论：凡老年人轻微外伤后出现皮肤红肿，局部病变迅速发展,全身中毒症状重，应考虑到本病可能，治疗应采取以手术充分切开引流为主的综合治疗。     

Conservative management of necrotizing fascitis in children

Background

Necrotizing fascitis (NF) is a severe infection of the subcutaneous tissue and fascia affecting children and adults. Conventional management includes resuscitation, aggressive debridement of necrotic tissue, and sometimes, additional measures such as hyperbaric oxygen and immunoglobulin therapy. This paper reports conservative management of 18 patients with NF with minimal morbidity and mortality.

Material and Methods

Patients with NF admitted to our department between January 2000 and February 2004 were included in the study (N = 18). In all cases, the presentation was rapidly progressing cellulitis progressing to cutaneous gangrene between 6 and 18 hours. The patients were managed by aggressive fluid resuscitation, analgesia, broad-spectrum antibiotics, and dressing with liberal quantities of povidone iodine ointment. After separation of the gangrenous skin margins from the surrounding healthy tissue between 24 and 72 hours, dead skin and fascia were removed with forceps on the ward, the wound washed with liberal quantities of water, and the ointment dressing reapplied. This procedure was repeated until all the dead tissue had been removed. Once the wound was granulating, dressings were changed at increasing intervals until healing took place by secondary intention.

Results

The patients were aged between 5 days and 11 years. In all, NF began as a small boil progressing to a rapidly spreading cellulitis. None of the patients was operated during the acute stage of the infection. Blackening of the skin and separation of the edges occurred within 8-72 hours, the dead tissue was allowed to separate from the granulating base and could be removed at the bedside with minimal blood loss. Blood transfusion was required only in 2 patients where hemoglobin was < 9 gm/dL. Of the 18 patients, 6 grew group A streptococci and staphylococci in a polymicrobial wound culture, whereas the other 12 had polymicrobial flora without streptococci. The clinical course and outcomes were similar in both types of wounds. There was 1 death in the study group, and 1 patient required skin grafting. All other survivors had healing by secondary intention without disability. The period for complete epithelization varied between 3 and 8 weeks. Patients were discharged home when 70% of the wound had healed. There was extensive scarring in 3 children with NF involving the back. The other children had minimal or no scarring. None of the patients had any restriction in the movement of limbs or joints. These findings were compared with 16 retrospective patients of NF treated before January 2000 by the conventional approach of aggressive early debridement, the results of the conservative approach were superior with shorter hospital stay, lower number of blood transfusions, earlier appearance of granulation tissue, and shorter duration of complete healing.

Conclusions

We conclude that the conservative management of NF offers advantages in morbidity without compromising the outcome. In our hospital setup, conservative treatment was less expensive and easily carried out. We would therefore advocate conservative management for the treatment of this condition.     

Descending necrotizing mediastinitis. Diagnosis and surgical treatment

AIM: Descending necrotizing mediastinitis (DNM) is an unusual and severe disease with a high mortality rate. Surgical management remains controversial. Our investigations reviews the most effective surgical treatment in the management of this rare pathology. METHODS: Seven patients with DNM and treated over a 20-year period are reported. All patients were evaluated according to the classification suggested by Endo et al. of the degree of mediastinal diffusion, based on CT scan findings. Five patients underwent combined cervical drainage and thoracotomy, 2 patients were treated with cervical drainage alone. RESULTS: The outcome was favorable in 5 patients, 4 treated with a combined cervical and thoracic approach and 1 with a cervical approach alone. Two patients that underwent a combinated cervical and thoracic approach alone, died of septic shock. Overall mortality rate was 28.5%. CONCLUSION: Early diagnosis and early, aggressive surgical treatment are required to improve the poor prognosis of DNM. Although a unique surgical management is still not completely accepted, we state, in agreement with other authors, a wide approach consisting of a cervical drainage and mediastinotomy in case of upper mediastinitis and a combined cervical and thoracic approach in case of lower mediastinitis. In the course of thoracotomy a wide excision of necrotic and particularly fat mediastinal tissue is needed, to avoid a recurrent infection. A continuous cervico-mediastinal irrigation system is suggested during the postoperative period.     

肛周脓肿致急性坏死性筋膜炎的诊治

目的探讨肛周脓肿致急性坏死性筋膜炎的规律和诊治方法。方法回顾性总结我科经治的肛周脓肿伴急性坏死性筋膜炎9例患者的临床资料。结果 9例患者中8例经手术切开清除坏死组织及抗感染等治疗后治愈,1例因拒绝手术而未及时行切开引流的死于脓毒血症、全身多器官衰竭。结论对于肛周脓肿致急性坏死性筋膜炎宜早确诊,早治疗,手术开窗留桥对口彻底切开引流,并加强抗感染对症支持是关键。     

Usefulness and safety of open tracheostomy by a paramedian approach for cervical infection: esophageal and tracheal injury and necrotizing fascitis

Tracheostomy is hardly performed in patients with cervical infection close to the site of the tracheostomy. This study aimed to present and clarify the usefulness and safety of open tracheostomy performed by the paramedian approach technique. The procedure is as follows. A 2.5-cm paramedian incision is made for the tracheostomy on the opposite side of infectious focus; the anterior neck muscles are dissected and split; the trachea is fenestrated by a reverse U-shaped incision; and the fenestral flap of the trachea is fixed to the skin. We used this technique in five patients. There were no complications such as bleeding, desaturation, and displacement of the tube; and there were no postoperative complications such as severe contamination or infection of the tracheostomy site from the nearby cervical wound, difficulty in securing the tracheostomy tube and connecting device to the ventilator, difficulties in daily management and care, or dislocation of the tracheostomy tube. All wounds resulting from the tracheostomy were kept separate from and not contaminated by the nearby dirty wounds. Open tracheostomy by the paramedian approach technique is useful and safe for patients with severe cervical infection requiring open drainage and long ventilatory management.     

Pre-expanded epigastric flap cover for ventral hernia following fungal necrotizing fascitis of caesarian section wound: An unusual complication

Introduction

Reconstruction of anterior abdominal wall after necrotizing abdominal wall infections is a challenge.

Material and methods

A 35-year-old lady presented with 20 × 18 cm sized defect of the anterior abdominal wall following fungal necrotizing fascitis. The defect was covered by an overlay prolene mesh and the soft tissue deficit was corrected by pre-expanded epigastric flap based on the superior epigastric artery.

Conclusion

A concerted multi-specialty effort is needed to correct these defects.

     

Diagnosis and therapy of necrotizing fasciitis

Necrotizing fasciitis is a soft tissue infection with a lethality ranging up to 80%. Infection causes the activation of interleukin, tumor necrosis factor alpha, and gamma-interferon through a triggering mechanism. This results in a capillary thrombosis with necrosis of the fascia, cutis, and subcutis. The patient's history often reveals a triggering event in the form of a recent minimal trauma or operative procedure. In a fulminant necrotizing fasciitis, the development of sepsis with consecutive multiple-organ failure mainly determines the outcome of the disease. Diagnosis is made initially upon clinical findings with a rapid progression of the disease and confirmed later by histologic and microbiologic findings. Radical surgical debridement within the first 24 h with postoperative treatment in an intensive care unit represents the cornerstone of therapy. Between January 1992 and March 2001, we treated 15 patients with necrotizing fasciitis. Lethality was 33%. There was a significant correlation between risk factors (present in 86% of the patients) and morbidity. Diagnosis and therapy should be performed by an experienced surgeon. In this contribution, we discuss the most important criteria that lead to the diagnosis and the therapeutic consequences.