scholarly journals Necrotizing Fasciitis of the Left Lower Limb Complicated with the Abscess of Retroperitoneal Space: Case Report Presentation and a Retrospective Study

2021 ◽  
Author(s):  
Chao Wang ◽  
Fan Zhang ◽  
Zhensheng Hu
Keyword(s):  
Septic Shock ◽  
Case Report ◽  
Retrospective Study ◽  
Antibiotic Therapy ◽  
Lower Limb ◽  
Negative Pressure Wound Therapy ◽  
Retroperitoneal Space ◽  
Wound Therapy ◽  
Left Lower Limb ◽  
Prompt Diagnosis

Abstract Background: Necrotizing fasciitis(NF) is a severe progressive infectious disease where a synergistic action of multiple bacteria results in suppurative necrosis of the skin and soft tissue. Despite being a relatively uncommon infection, its mortality is significantly high. In this case report ,we describe the clinical presentation, management and outcome of a patient with NF of the left lower limb complicated with the abscess of retroperitoneal space and ensuing septic shock and dysfunction of heart and liver. Finally, we analyzed six cases we have treated before including this one and a retrospective study was performed.Case presentation: A 69-year-old male patient, complaining about the pain of left lower limb and high fever due to uncertain reasons, featuring the tenderness of affected limb and left lower abdomen , was diagnosed with the NF complicated with the abscess of retroperitoneal space. The patient then develop septic shock and dysfunction of heart and liver. After repeated debridement of necrosis tissue, in combination with multiple antibiotics, laboratory test methods and the vacuum-assisted closure(VAC) therapy, the patient survived ,gradually improved and finally got a full recovery.Methods: A retrospective study was performed on six patients with NF of unilateral lower limb from March 2018 to October 2019. All patients were given systemic antibiotics and nutrition support. During the first stage, repeated surgical debridement with negative-pressure wound therapy(NPWT) was performed. Direct suture of the wound was performed in the second stage. Results: The incision healed well in all patients, and no infection or necrosis occurred in the wound. During the follow-up of 6.5 months (range, 5-9 months), no recurrence of infection or incision rupture occurred.Discussion: Although prompt diagnosis and adequate antibiotic therapy are basic for the treatment of patients with NF, early and repeated surgical intervention is vital for a favorable outcome. Thus, adjuvant treatment for NF such as negative pressure wound therapy (NPWT) using the VAC are very useful to accelerate wound healing.Conclusions: Prompt diagnosis, adequate antibiotic therapy and more crucially, early and repeated surgical debridement of the necrotic tissue combined with VAC therapy play a collaborative role in the successful treatment of NF.

scholarly journals Necrotizing fasciitis of the left lower limb complicated with the abscess of retroperitoneal space: case report presentation and a retrospective study

2021 ◽  
Author(s):  
Chao Wang ◽  
Xujin Liu ◽  
Fan Zhang
Keyword(s):  
Septic Shock ◽  
Case Report ◽  
Retrospective Study ◽  
Antibiotic Therapy ◽  
Negative Pressure ◽  
Lower Limb ◽  
Negative Pressure Wound Therapy ◽  
Retroperitoneal Space ◽  
Wound Therapy ◽  
Left Lower Limb

Abstract BackgroundNecrotizing fasciitis(NF) is a severe progressive infectious disease where a synergistic action of multiple bacteria results in suppurative necrosis of the skin and soft tissue. Despite being a relatively uncommon infection, its mortality is significantly high. In this case report ,we describe the clinical presentation, management and outcome of a patient with NF of the left lower limb complicated with the abscess of retroperitoneal space and ensuing septic shock and dysfunction of heart and liver. Finally, we analyzed six cases we have treated before including this one and a retrospective study was performed.Case presentationA 69-year-old male patient, complaining about the pain of left lower limb and high fever due to uncertain reasons, featuring the tenderness of affected limb and left lower abdomen, was diagnosed with the NF complicated with the abscess of retroperitoneal space. The patient then develop septic shock and dysfunction of heart and liver. After repeated debridement of necrosis tissue, in combination with multiple antibiotics, laboratory test methods and the vacuum-assisted closure(VAC) therapy, the patient survived ,gradually improved and finally got a full recovery.MethodsA retrospective study was performed on six patients with NF of unilateral lower limb from March 2018 to October 2019. All patients were given systemic antibiotics and nutrition support. During the first stage, repeated surgical debridement with negative-pressure wound therapy(NPWT) was performed. Direct suture of the wound was performed in the second stage.ResultsThe incision healed well in all patients, and no infection or necrosis occurred in the wound. During the follow-up of 6.5 months (range, 5–9 months), no recurrence of infection or incision rupture occurred.DiscussionAlthough prompt diagnosis and adequate antibiotic therapy are basic for the treatment of patients with NF, early and repeated surgical intervention is vital for a favorable outcome. Thus, adjuvant treatment for NF such as negative pressure wound therapy (NPWT) using the VAC are very useful to accelerate wound healing.ConclusionsPrompt diagnosis, adequate antibiotic therapy and more crucially, early and repeated surgical debridement of the necrotic tissue combined with VAC therapy play a collaborative role in the successful treatment of NF.

Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽  
2020 ◽  
pp. 1-6 ◽  
Author(s):  
Marina Di Pilla ◽  
Stefano Barco ◽  
Clara Sacco ◽  
Giovanni Barosi ◽  
Corrado Lodigiani
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Review Of The Literature ◽  
Heparin Induced Thrombocytopenia ◽  
Lower Limb Ischemia ◽  
Vein Thrombosis ◽  
Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

Osteoradionecrosis and microvascular free flap failure managed with negative pressure wound therapy: A case report

2021 ◽  
pp. 1-6
Author(s):  
Michael J. Gigliotti ◽  
Neel Patel ◽  
Caroline McLaughlin ◽  
Alexis Rothermel ◽  
Cathy Henry ◽  
...  
Keyword(s):  
Case Report ◽  
Free Flap ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Therapy ◽  
Flap Failure ◽  
Microvascular Free Flap

scholarly journals A 13 cm asymptomatic abdominal aortic aneurysm complicated with arterial obstruction in the left lower limb: A Case report

2021 ◽  
Vol 70 ◽  
pp. 102815
Author(s):  
Sarya Swed ◽  
Salim Tfankji ◽  
Hussein Alkanj ◽  
Tasneem Mohamed ◽  
Nawras Alhalabi ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Case Report ◽  
Aortic Aneurysm ◽  
Lower Limb ◽  
Abdominal Aortic ◽  
Left Lower Limb

Step-up approach combined with negative pressure wound therapy for the treatment of severe necrotizing pancreatitis: a case report

2020 ◽  
Vol 13 (6) ◽  
pp. 1331-1337
Author(s):  
Yosuke Namba ◽  
Yasuhiro Matsugu ◽  
Masaru Furukawa ◽  
Maiko Namba ◽  
Tamito Sasaki ◽  
...  
Keyword(s):  
Case Report ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Necrotizing Pancreatitis ◽  
Wound Therapy

scholarly journals Left Lower Limb Arteriovenous Malformation at Term Gestation: A Case Report

2021 ◽  
Vol 13 (3) ◽  
pp. 187-189
Author(s):  
Christy Vijay ◽  
Medini Lakshmeswar ◽  
SK Manjula
Keyword(s):  
Case Report ◽  
Arteriovenous Malformation ◽  
Lower Limb ◽  
Left Lower Limb

scholarly journals Negative-pressure wound therapy compared with standard dressings following surgical treatment of major trauma to the lower limb: the WHiST RCT

2020 ◽  
Vol 24 (38) ◽  
pp. 1-86
Author(s):  
Matthew L Costa ◽  
Juul Achten ◽  
Ruth Knight ◽  
May Ee Png ◽  
Julie Bruce ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Site Infection ◽  
Negative Pressure ◽  
Lower Limb ◽  
Negative Pressure Wound Therapy ◽  
Major Trauma ◽  
Site Infection ◽  
Wound Therapy ◽  
Deep Surgical Site Infection

Background Major trauma is the leading cause of death in people aged < 45 years. Patients with major trauma usually have lower-limb fractures. Surgery to fix the fractures is complicated and the risk of infection may be as high as 27%. The type of dressing applied after surgery could potentially reduce the risk of infection. Objectives To assess the deep surgical site infection rate, disability, quality of life, patient assessment of the surgical scar and resource use in patients with surgical incisions associated with fractures following major trauma to the lower limbs treated with incisional negative-pressure wound therapy versus standard dressings. Design A pragmatic, multicentre, randomised controlled trial. Setting Twenty-four specialist trauma hospitals representing the UK Major Trauma Network. Participants A total of 1548 adult patients were randomised from September 2016 to April 2018. Exclusion criteria included presentation > 72 hours after injury and inability to complete questionnaires. Interventions Incisional negative-pressure wound therapy (n = 785), in which a non-adherent absorbent dressing covered with a semipermeable membrane is connected to a pump to create a partial vacuum over the wound, versus standard dressings not involving negative pressure (n = 763). Trial participants and the treating surgeon could not be blinded to treatment allocation. Main outcome measures Deep surgical site infection at 30 days was the primary outcome measure. Secondary outcomes were deep infection at 90 days, the results of the Disability Rating Index, health-related quality of life, the results of the Patient and Observer Scar Assessment Scale and resource use collected at 3 and 6 months post surgery. Results A total of 98% of participants provided primary outcome data. There was no evidence of a difference in the rate of deep surgical site infection at 30 days. The infection rate was 6.7% (50/749) in the standard dressing group and 5.8% (45/770) in the incisional negative-pressure wound therapy group (intention-to-treat odds ratio 0.87; 95% confidence interval 0.57 to 1.33; p = 0.52). There was no difference in the deep surgical site infection rate at 90 days: 13.2% in the standard dressing group and 11.4% in the incisional negative-pressure wound therapy group (odds ratio 0.84, 95% confidence interval 0.59 to 1.19; p = 0.32). There was no difference between the two groups in disability, quality of life or scar appearance at 3 or 6 months. Incisional negative-pressure wound therapy did not reduce the cost of treatment and was associated with a low probability of cost-effectiveness. Limitations Owing to the emergency nature of the surgery, we anticipated that some patients who were randomised would subsequently be unable or unwilling to participate. However, the majority of the patients (85%) agreed to participate. Therefore, participants were representative of the population with lower-limb fractures associated with major trauma. Conclusions The findings of this study do not support the use of negative-pressure wound therapy in patients having surgery for major trauma to the lower limbs. Future work Our work suggests that the use of incisional negative-pressure wound therapy dressings in other at-risk surgical wounds requires further investigation. Future research may also investigate different approaches to reduce postoperative infections, for example the use of topical antibiotic preparations in surgical wounds and the role of orthopaedic implants with antimicrobial coatings when fixing the associated fracture. Trial registration Current Controlled Trials ISRCTN12702354 and UK Clinical Research Network Portfolio ID20416. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 38. See the NIHR Journals Library for further project information.

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