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

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.

Keywords

• Diklofenak sodyum
• enjeksiyon
• intramüsküler
• Nicolau sendromu

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

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.

Keywords

• Diclofenac sodium
• injection
• intramuscular
• Nicolau syndrome

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