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

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

Rüştü Köse Özgür Söğüt Atilla Kamaz Mustafa Burak Sayhan

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

Keywords

Nekrotizan yumuşak doku enfeksiyonları NYDE, Erken teşhis ve tedavi, Debridman

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

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

Keywords

Necrotizing soft-tissue infections NSTI , Early diagnosis and treatment, Debridement

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