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Geniş Tutulumlu Nekrotizan Yumuşak Doku Enfeksiyonları: Literatürün Gözden Geçirilmesi Ve İki Olgu Sunumu

Year 2008, Volume: 5 Issue: 3, 30 - 36, 01.12.2008

Abstract

Nekrotizan yumuşak doku enfeksiyonları NYDE deri ve yüzeyel fasyanın nadir görülen, hızlı ilerleyen ölümcül olabilen hastalıklarıdır. NYDE tedavisi erken teşhis, tüm nekrotik dokuların hızlı debridmanı, geniş spektrumlu antibiyotik kullanımı ve destek tedavisinden oluşur. Hayatı tehdit eden bu enfeksiyonlar genelde yanlışlıkla selilüt ya da masum yara enfeksiyonu olarak değerlendirilirler ve buda teşhisin gecikmesine neden olur. Cerrahi tedavide insizyon ve drenaj uygun tedavi yöntemi değildir, eksizyonel debridman yapılmalıdır. Cerrahi tekniklerdeki gelişmeler ve yeni bulunan ilaçlara rağmen bu enfeksiyonlardan ölüm oranı halen yüksektir. NYDE teşhis ve tedavisi, Genel cerrahi, Plastik ve rekonstrüktif cerrahi, Enfeksiyon hastalıkları, Acil tıp, Anestezi ve reanimasyon uzmanlarından oluşan hekimler tarafından yapıldığında daha başarılı sonuçlar alınabilmektedir. Bu yazıda ilk başvuruda tanı ve tedavisi gecikmiş,acil serviste ve yoğun bakımda takip ettiğimiz iki adet NYDE’ lu olguyu sunmayı ve literatürü gözden geçirerek predizpozan faktörleri,erken teşhis ve tedaviyi tartışmayı amaçladık

References

  • McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995; 221: 558-63.
  • Meleney FL. Hemolytic streptococcal gangrene. Arch Surg 1924; 9: 317- 64.
  • Wilson B. Necrotizing fasciitis. Am Surg 1952; 18: 416- 31.
  • Ayhan S, Demirtaş Y, Biri A, Başterzi Y, Bayramoğlu Ö, Latifoğlu O, ve ark. Ölümcül Nekrotizan Yumuşak Doku Enfeksiyonu: Derleme Ve İki Olgu Sunumu. Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Dergisi 2004; 12: 69-73.
  • Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest 1996; 110: 219-29.
  • Urschel JD. Necrotizing soft tissue infections. Postgrad Med J 1999; 75: 645-9.
  • Bosshardt TL, Henderson VJ, Organ CH Jr. Necrotizing soft-tissue infections. Arch Surg 1996; 131: 846-52.
  • Clark LA, Moon RE. Hyperbaric oxygen in the treatment of life-threatening soft-tissue infections. Respir Care Clin N Am 1999; 5: 203-19.
  • Wang KC, Shih CH. Necrotizing fasciitis of the extremities. J Trauma 1992; 32: 179-82.
  • Heitmann C, Czermak C, Germann G. Rapidly fatal necrotizing fasciitis after aesthetic liposuction. Aesthetic Plast Surg 2000; 24: 344-7.
  • Headley AJ. Necrotizing soft tissue infections: a primary care review. Am Fam Physician 2005; 68: 323-8.
  • Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 1996; 224: 672-83.
  • McHenry CR, Brandt CP, Piotrowski JJ, Jacobs DG, Malangoni MA. Idiopathic necrotizing fasciitis: recognition, incidence, and outcome of therapy. Am Surg 1994; 60:490-4.
  • Özgenel GY, Akın S, Kahveci R, Özbek S, Özcan M. Nekrotizan fasitli 30 hastanın klinik değerlendirilmesi ve tedavi sonuçları. Ulusal Travma ve Acil Cerrahi Dergisi 2004; 10(2): 110-114.
  • Wilkerson R, Paull W, Coville FV. Necrotizing fasciitis. Review of the literature and case report. Clin Orthop Relat Res 1987; 216:187-92.
  • Ward RG, Walsh MS. Necrotizing fasciitis: 10 years' experience in a district general hospital. Br J Surg 1991; 78: 488-9.
  • Canoso JJ, Barza M. Soft tissue infections. Rheum Dis Clin North Am 1993; 19: 293- 309.
  • Gozal D, Ziser A, Shupak A, Ariel A, Melamed Y. Necrotizing fasciitis. Arch Surg 1986; 121: 233-5.
  • Liu YM, Chi CY, Ho MW, Chen CM, Liao WC, Ho CM, et al. Microbiology and factors affecting mortality in necrotizing fasciitis. J Microbiol Immunol Infect 2005; 38: 430-5.
  • Chelsom J, Halstensen A, Haga T, Hİiby EA. Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features. Lancet 1994; 344: 1111- 5.
  • Webb HE, Hoover NW, Nıchols DR, Weed LA. Streptococcal gangrene. Arch Surg 1962; 85: 969-73.
  • Fisher JR, Conway MJ, Takeshita RT, Sandoval Importance of roentgenographic studies for soft-tissue gas. JAMA 1979; 241: 803-6.
  • Rahmouni A, Chosidow O, Mathieu D, Gueorguieva E, Jazaerli N, Radier C, et al. MR imaging in acute infectious cellulitis. Radiology 1994; 192: 493-6.
  • Burge TS, Watson JD. Necrotising fasciitis. BMJ. 1994; 308: 1453-4.
  • Sudarsky LA, Laschinger JC, Coppa GF, Spencer FC. Improved results from a standardized approach in treating patients with necrotizing fasciitis. Ann Surg 1987; 206: 661-5.

Large Necrotizing Soft-Tissue Infections: A Review Of The Literature And Report Of Two Cases

Year 2008, Volume: 5 Issue: 3, 30 - 36, 01.12.2008

Abstract

Necrotizing soft-tissue infections NSTIs are a rare, rapidly progressive, and often fatal infection of skin and superficial fascia. NSTI treatments consist of early diagnosis, radical surgical debridement of all involved necrotic tissue, use of broad spectrum antibiotics, and aggressive nutritional support.These life-threatening infections are often mistaken for cellulitis or innocent wound infections, and this causes for diagnostic delay. Incision and drainage is an inappropriate surgical strategy for NSTIs; excisional debridement is needed. Despite advances in surgical techniques and newly invented medicine, the mortality of NSTIs is still high. The entire therapeutic process requires a well-prepared and coordinated team of health care professionals including EPs, general surgery, plastic and reconstructive surgery, infectious disease, emergency medicine,anesthesiology and reanimation consultants. In this article; we aimed to discuss early diagnosis and treatment of the two cases in NSTI patients having later diagnosis and treatment that we observed in emergency department and intensive care by revisioning literature and predisposition factors. Key Wodrs: Necrotizing soft-tissue infections NSTI , Early diagnosis and treatment,Debridement

References

  • McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995; 221: 558-63.
  • Meleney FL. Hemolytic streptococcal gangrene. Arch Surg 1924; 9: 317- 64.
  • Wilson B. Necrotizing fasciitis. Am Surg 1952; 18: 416- 31.
  • Ayhan S, Demirtaş Y, Biri A, Başterzi Y, Bayramoğlu Ö, Latifoğlu O, ve ark. Ölümcül Nekrotizan Yumuşak Doku Enfeksiyonu: Derleme Ve İki Olgu Sunumu. Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Dergisi 2004; 12: 69-73.
  • Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest 1996; 110: 219-29.
  • Urschel JD. Necrotizing soft tissue infections. Postgrad Med J 1999; 75: 645-9.
  • Bosshardt TL, Henderson VJ, Organ CH Jr. Necrotizing soft-tissue infections. Arch Surg 1996; 131: 846-52.
  • Clark LA, Moon RE. Hyperbaric oxygen in the treatment of life-threatening soft-tissue infections. Respir Care Clin N Am 1999; 5: 203-19.
  • Wang KC, Shih CH. Necrotizing fasciitis of the extremities. J Trauma 1992; 32: 179-82.
  • Heitmann C, Czermak C, Germann G. Rapidly fatal necrotizing fasciitis after aesthetic liposuction. Aesthetic Plast Surg 2000; 24: 344-7.
  • Headley AJ. Necrotizing soft tissue infections: a primary care review. Am Fam Physician 2005; 68: 323-8.
  • Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 1996; 224: 672-83.
  • McHenry CR, Brandt CP, Piotrowski JJ, Jacobs DG, Malangoni MA. Idiopathic necrotizing fasciitis: recognition, incidence, and outcome of therapy. Am Surg 1994; 60:490-4.
  • Özgenel GY, Akın S, Kahveci R, Özbek S, Özcan M. Nekrotizan fasitli 30 hastanın klinik değerlendirilmesi ve tedavi sonuçları. Ulusal Travma ve Acil Cerrahi Dergisi 2004; 10(2): 110-114.
  • Wilkerson R, Paull W, Coville FV. Necrotizing fasciitis. Review of the literature and case report. Clin Orthop Relat Res 1987; 216:187-92.
  • Ward RG, Walsh MS. Necrotizing fasciitis: 10 years' experience in a district general hospital. Br J Surg 1991; 78: 488-9.
  • Canoso JJ, Barza M. Soft tissue infections. Rheum Dis Clin North Am 1993; 19: 293- 309.
  • Gozal D, Ziser A, Shupak A, Ariel A, Melamed Y. Necrotizing fasciitis. Arch Surg 1986; 121: 233-5.
  • Liu YM, Chi CY, Ho MW, Chen CM, Liao WC, Ho CM, et al. Microbiology and factors affecting mortality in necrotizing fasciitis. J Microbiol Immunol Infect 2005; 38: 430-5.
  • Chelsom J, Halstensen A, Haga T, Hİiby EA. Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features. Lancet 1994; 344: 1111- 5.
  • Webb HE, Hoover NW, Nıchols DR, Weed LA. Streptococcal gangrene. Arch Surg 1962; 85: 969-73.
  • Fisher JR, Conway MJ, Takeshita RT, Sandoval Importance of roentgenographic studies for soft-tissue gas. JAMA 1979; 241: 803-6.
  • Rahmouni A, Chosidow O, Mathieu D, Gueorguieva E, Jazaerli N, Radier C, et al. MR imaging in acute infectious cellulitis. Radiology 1994; 192: 493-6.
  • Burge TS, Watson JD. Necrotising fasciitis. BMJ. 1994; 308: 1453-4.
  • Sudarsky LA, Laschinger JC, Coppa GF, Spencer FC. Improved results from a standardized approach in treating patients with necrotizing fasciitis. Ann Surg 1987; 206: 661-5.
There are 25 citations in total.

Details

Primary Language Turkish
Journal Section Case Report
Authors

Rüştü Köse This is me

Özgür Söğüt This is me

Atilla Kamaz This is me

Mustafa Burak Sayhan This is me

Publication Date December 1, 2008
Published in Issue Year 2008 Volume: 5 Issue: 3

Cite

Vancouver Köse R, Söğüt Ö, Kamaz A, Sayhan MB. Geniş Tutulumlu Nekrotizan Yumuşak Doku Enfeksiyonları: Literatürün Gözden Geçirilmesi Ve İki Olgu Sunumu. Harran Üniversitesi Tıp Fakültesi Dergisi. 2008;5(3):30-6.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty