Research Article
BibTex RIS Cite

Diklofenak Sodyum Ekjeksiyonuna Bağlı Doku Nekrozunun (Nicolau Sendromu) Cerrahi Tedavisi

Year 2020, Volume: 22 Issue: 3, 222 - 225, 30.12.2020
https://doi.org/10.18678/dtfd.793799

Abstract

Amaç: Nicolau sendromu (NS), bazı ilaçların enjeksiyonlarını takiben gelişen ve yaklaşık bir perforazomu kaplayan boyutlara ulaşan yumuşak doku ve ciltte nekroz gelişmesi durumudur. Bu çalışmada klinikte sık karşılaşılmayan diklofenak sodyum enjeksiyonu sonrası gelişmiş bu nadir patolojiye yönelik klinik yaklaşımımız ve tedavi alternatiflerinin sunulması amaçlanmıştır.
Gereç ve Yöntemler: Bu geriye dönük çalışmada diklofenak sodyum enjeksiyonu sonrası enjeksiyon yerinde NS gelişen 16 hastaya yaklaşımımız değerlendirildi. Hastaların demografik verileri, eşlik eden hastalıkları, nekrozun yerleşimi ve boyutları ve cerrahi teknikler tarandı. Postoperatif komplikasyonlar, hastanede kalış süresi ve sonuçlar değerlendirildi.
Bulgular: Toplam 16 hasta mevcut olup bunların 14'ü kadın 2'si erkek idi. Ortalama yaş 60±14,4 yıl ve ortalama vücut kitle indeksi (VKİ) 33±1,4 kg/m2 idi. En sık eşlik eden hastalık diyabetes mellitus, daha sonra primer hipertansiyon olarak gözlendi. Ortalama nekroz boyutu 8x8x5 cm olarak saptandı. Tüm 16 nekroza da cerrahi debridman uygulandı. Nekrozun cerrahi debridmanı sonrası 8 hastanın defekti primer kapatılırken 6 hastada fasyokutan flep yapıldı ve 2 hasta ise bir hafta sonra gecikmiş primer olarak onarıldı. Hastaların tümü sorunsuz olarak tamamen iyileşti.
Sonuç: Yüksek VKİ, diyabetes mellitus ve primer hipertansiyon gibi komorbid özellikler taşıyan hastalara diklofenak sodyum enjeksiyonu yapılırken çok dikkatli olunmalıdır. İşlem sırasında, iğnenin kas tabakasına kadar ulaştığından ve perforatör bir damara denk gelmediğinden emin olunmalıdır. Enjeksiyon sonrası nekroz gelişmesi durumunda erken dönemde cerrahi debridmanı takiben rekonstrüksiyon etkili bir tedavidir.

References

  • Nischal K, Basavaraj H, Swaroop M, Agrawal D, Sathyanarayana B, Umashankar N. Nicolau syndrome: an iatrogenic cutaneous necrosis. J Cutan Aesthet Surg. 2009;2(2):92-5.
  • Senel E. Nicolau syndrome as an avoidable complication. J Family Community Med. 2012;19(1):52-3.
  • Kılıç İ, Kaya F, Özdemir AT, Demirel T, Çelik İ. Nicolau syndrome due to diclofenac sodium (Voltaren) injection: a case report. J Med Case Rep. 2014;8:404.
  • Lardelli PF, Jermini LMM, Milani GP, Peeters GGAM, Ramelli GP, Zgraggen L, et al. Nicolau syndrome caused by non-steroidal anti-inflammatory drugs: Systematic literature review. Int J Clin Pract. 2020;74(10):e13567.
  • Kim KK, Chae DS. Nicolau syndrome: a literature review. World J Dermatol. 2015;4(2):103-7.
  • Yeniocak A, Kelahmetoğlu O, Özkan M, Temel M, Güneren E. A basic algorithmic surgical approach for Nicolau syndrome. J Cutan Aesthet Surg. 2020;13(2):154-9.
  • Malik MH, Heaton H, Sloan B. Nicolau syndrome following intramuscular naltrexone injection. Dermatol Online J. 2020;26(7):13030/qt3gb5m0vr.
  • Ezzedine K, Vadoud-Seyedi J, Heenen M. Nicolau syndrome following diclofenac administration. Br J Dermatol. 2004;150(2):385-7.
  • Senel E. Nicolau syndrome as an avoidable complication. J Fam Community Med. 2012;19(1):52-3.
  • Guarneri C, Polimeni G. Nicolau syndrome following etanercept administration. Am J Clin Dermatol. 2010;11(Suppl 1):51-2.
  • Zargarbashi R, Panjavi B, Keshavarz-Fathi M. Extensive deep tissue involvement in Nicolau syndrome and below-knee amputation: A case report and literature review. Int J Low Extrem Wounds. 2020;[Epub ahead of print]. doi: 10.1177/1534734620948768.
  • Saputo V, Bruni G. Nicolau syndrome caused by penicillin preparations: review of the literature in search for potential risk factors. Pediatr Med Chir. 1998;20(2):105-23.
  • Taylan Filinte G, Akan M, Filinte D, Gönüllü ME, Aköz T. Gluteal injections: As harmless as we think? Case report. South Clin Ist Euras. 2010;21(2):89-93.
  • Murthy SC, Siddalingappa K, Suresh T. Nicolau's syndrome following diclofenac administration: A report of two cases. Indian J Dermatol Venereol Leprol. 2007;73(6):429-31.
  • Kocman EA, Yaşar FN, Kose AA, Cil Y, Karabagli Y, Çetin C. Freestyle perforator-based fasciocutaneous flap reconstruction in Nicolau syndrome-related tissue necrosis. Indian J Surg. 2015;77(Suppl 3):1187-90.
  • Dadaci M, Altuntas Z, Ince B, Bilgen F, Tufekci O, Poyraz N. Nicolau syndrome after intramuscular injection of non-steroidal anti-inflammatory drugs (NSAID). Bosn J Basic Med Sci. 2015;15(1):57-60.
  • Probst M, Kühn JP, Modeß C, Scheuch E, Seidlitz A, Hosten N, et al. Muscle injury after intramuscular administration of diclofenac: A case report supported by magnetic resonance imaging. Drug Saf Case Rep. 2017;4(1):7.
  • Aktas H, Yılmaz OE, Ertugrul G, Terzi E. Intramuscular diclofenac is a cause of Nicolau syndrome in obese women: An observational study of consecutive ten patients. Dermatol Ther. 2020;33(3):e13392.
  • Corazza M, Capozzi O, Virgilit A. Five cases of livedo-like dermatitis (Nicolau's syndrome) due to bismuth salts and various other non-steroidal anti-inflammatory drugs. J Eur Acad Dermatol Venereol. 2001;15(6):585-8.
  • Pullen RL Jr. Administering medication by the Z-track method. Nursing. 2005;35(7):24.

The Surgical Treatment of Tissue Necrosis due to Diclofenac Sodium Injection (Nicolau Syndrome)

Year 2020, Volume: 22 Issue: 3, 222 - 225, 30.12.2020
https://doi.org/10.18678/dtfd.793799

Abstract

Aim: Nicolau syndrome (NS) is the necrosis of skin and subcuticular tissue, following injection of many drugs, which covers nearly a perforasome. This study aims to unveil our clinical approach and treatment alternatives against this rare pathology subsequent to diclofenac sodium.
Material and Methods: In this retrospective study, our approach to 16 patients who developed NS at the injection site after diclofenac sodium injection was evaluated. Patients’ demographic data, concomitant diseases, location and size of necrosis, and surgical techniques were collected. Post-operative complications, hospitalization period and results were evaluated.
Results: There were total of 16 patients, 2 of which were male and 14 were female. The mean age was 60±14.4 years, and the mean body mass index (BMI) was 33±1.4 kg/m2. The major concomitant comorbidity was diabetes mellitus, followed by primary hypertension. The mean defect size was 8x8x5 cm. Surgical debridement was applied to all 16 necrosis. Following the surgical debridement of necrosis, 8 patients were reconstructed with primary closure, 6 patients with fasciocutaneous flaps and 2 patients with delayed primary closure after a week. All patients heal completely without complications.
Conclusion: Utmost care must be given when performing diclofenac sodium injections to the patients with comorbidities, such as high BMI, diabetes mellitus, and primary hypertension. The caregiver must be certain that the needle is in the muscular plane and no perforator vessel to be harmed during this procedure. In case of a post-injection necrosis, an early intervention with surgical debridement and reconstruction is an efficient treatment.

References

  • Nischal K, Basavaraj H, Swaroop M, Agrawal D, Sathyanarayana B, Umashankar N. Nicolau syndrome: an iatrogenic cutaneous necrosis. J Cutan Aesthet Surg. 2009;2(2):92-5.
  • Senel E. Nicolau syndrome as an avoidable complication. J Family Community Med. 2012;19(1):52-3.
  • Kılıç İ, Kaya F, Özdemir AT, Demirel T, Çelik İ. Nicolau syndrome due to diclofenac sodium (Voltaren) injection: a case report. J Med Case Rep. 2014;8:404.
  • Lardelli PF, Jermini LMM, Milani GP, Peeters GGAM, Ramelli GP, Zgraggen L, et al. Nicolau syndrome caused by non-steroidal anti-inflammatory drugs: Systematic literature review. Int J Clin Pract. 2020;74(10):e13567.
  • Kim KK, Chae DS. Nicolau syndrome: a literature review. World J Dermatol. 2015;4(2):103-7.
  • Yeniocak A, Kelahmetoğlu O, Özkan M, Temel M, Güneren E. A basic algorithmic surgical approach for Nicolau syndrome. J Cutan Aesthet Surg. 2020;13(2):154-9.
  • Malik MH, Heaton H, Sloan B. Nicolau syndrome following intramuscular naltrexone injection. Dermatol Online J. 2020;26(7):13030/qt3gb5m0vr.
  • Ezzedine K, Vadoud-Seyedi J, Heenen M. Nicolau syndrome following diclofenac administration. Br J Dermatol. 2004;150(2):385-7.
  • Senel E. Nicolau syndrome as an avoidable complication. J Fam Community Med. 2012;19(1):52-3.
  • Guarneri C, Polimeni G. Nicolau syndrome following etanercept administration. Am J Clin Dermatol. 2010;11(Suppl 1):51-2.
  • Zargarbashi R, Panjavi B, Keshavarz-Fathi M. Extensive deep tissue involvement in Nicolau syndrome and below-knee amputation: A case report and literature review. Int J Low Extrem Wounds. 2020;[Epub ahead of print]. doi: 10.1177/1534734620948768.
  • Saputo V, Bruni G. Nicolau syndrome caused by penicillin preparations: review of the literature in search for potential risk factors. Pediatr Med Chir. 1998;20(2):105-23.
  • Taylan Filinte G, Akan M, Filinte D, Gönüllü ME, Aköz T. Gluteal injections: As harmless as we think? Case report. South Clin Ist Euras. 2010;21(2):89-93.
  • Murthy SC, Siddalingappa K, Suresh T. Nicolau's syndrome following diclofenac administration: A report of two cases. Indian J Dermatol Venereol Leprol. 2007;73(6):429-31.
  • Kocman EA, Yaşar FN, Kose AA, Cil Y, Karabagli Y, Çetin C. Freestyle perforator-based fasciocutaneous flap reconstruction in Nicolau syndrome-related tissue necrosis. Indian J Surg. 2015;77(Suppl 3):1187-90.
  • Dadaci M, Altuntas Z, Ince B, Bilgen F, Tufekci O, Poyraz N. Nicolau syndrome after intramuscular injection of non-steroidal anti-inflammatory drugs (NSAID). Bosn J Basic Med Sci. 2015;15(1):57-60.
  • Probst M, Kühn JP, Modeß C, Scheuch E, Seidlitz A, Hosten N, et al. Muscle injury after intramuscular administration of diclofenac: A case report supported by magnetic resonance imaging. Drug Saf Case Rep. 2017;4(1):7.
  • Aktas H, Yılmaz OE, Ertugrul G, Terzi E. Intramuscular diclofenac is a cause of Nicolau syndrome in obese women: An observational study of consecutive ten patients. Dermatol Ther. 2020;33(3):e13392.
  • Corazza M, Capozzi O, Virgilit A. Five cases of livedo-like dermatitis (Nicolau's syndrome) due to bismuth salts and various other non-steroidal anti-inflammatory drugs. J Eur Acad Dermatol Venereol. 2001;15(6):585-8.
  • Pullen RL Jr. Administering medication by the Z-track method. Nursing. 2005;35(7):24.
There are 20 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Tolga Aksan 0000-0002-3328-2652

Uğur Kaan Kalem 0000-0002-6291-3978

Muhammed Beşir Öztürk 0000-0002-8977-3741

Cengiz Ertekin 0000-0003-4610-3219

Korhan Özkan 0000-0002-3755-1813

Publication Date December 30, 2020
Submission Date September 11, 2020
Published in Issue Year 2020 Volume: 22 Issue: 3

Cite

APA Aksan, T., Kalem, U. K., Öztürk, M. B., Ertekin, C., et al. (2020). The Surgical Treatment of Tissue Necrosis due to Diclofenac Sodium Injection (Nicolau Syndrome). Duzce Medical Journal, 22(3), 222-225. https://doi.org/10.18678/dtfd.793799
AMA Aksan T, Kalem UK, Öztürk MB, Ertekin C, Özkan K. The Surgical Treatment of Tissue Necrosis due to Diclofenac Sodium Injection (Nicolau Syndrome). Duzce Med J. December 2020;22(3):222-225. doi:10.18678/dtfd.793799
Chicago Aksan, Tolga, Uğur Kaan Kalem, Muhammed Beşir Öztürk, Cengiz Ertekin, and Korhan Özkan. “The Surgical Treatment of Tissue Necrosis Due to Diclofenac Sodium Injection (Nicolau Syndrome)”. Duzce Medical Journal 22, no. 3 (December 2020): 222-25. https://doi.org/10.18678/dtfd.793799.
EndNote Aksan T, Kalem UK, Öztürk MB, Ertekin C, Özkan K (December 1, 2020) The Surgical Treatment of Tissue Necrosis due to Diclofenac Sodium Injection (Nicolau Syndrome). Duzce Medical Journal 22 3 222–225.
IEEE T. Aksan, U. K. Kalem, M. B. Öztürk, C. Ertekin, and K. Özkan, “The Surgical Treatment of Tissue Necrosis due to Diclofenac Sodium Injection (Nicolau Syndrome)”, Duzce Med J, vol. 22, no. 3, pp. 222–225, 2020, doi: 10.18678/dtfd.793799.
ISNAD Aksan, Tolga et al. “The Surgical Treatment of Tissue Necrosis Due to Diclofenac Sodium Injection (Nicolau Syndrome)”. Duzce Medical Journal 22/3 (December 2020), 222-225. https://doi.org/10.18678/dtfd.793799.
JAMA Aksan T, Kalem UK, Öztürk MB, Ertekin C, Özkan K. The Surgical Treatment of Tissue Necrosis due to Diclofenac Sodium Injection (Nicolau Syndrome). Duzce Med J. 2020;22:222–225.
MLA Aksan, Tolga et al. “The Surgical Treatment of Tissue Necrosis Due to Diclofenac Sodium Injection (Nicolau Syndrome)”. Duzce Medical Journal, vol. 22, no. 3, 2020, pp. 222-5, doi:10.18678/dtfd.793799.
Vancouver Aksan T, Kalem UK, Öztürk MB, Ertekin C, Özkan K. The Surgical Treatment of Tissue Necrosis due to Diclofenac Sodium Injection (Nicolau Syndrome). Duzce Med J. 2020;22(3):222-5.