Reconstruction of gluteal defects related to Nicolau Syndrome secondary to intramuscular injection of diclofenac sodium with negative pressure wound therapy followed by skin graft.

Yıl 2016, , 270 - 4, 15.07.2016

Omer Kokacya , Ibrahim Tabakan , Eyuphan Gencel Cengiz Eser

https://doi.org/10.17546/msd.46783

Öz

Objective: Nicolau syndrome, synonymously livedo-like dermatitis or embolia cutis medicamentosa is a rare complication of drug injection leading to locoregional necrosis of the skin, adipose and muscular tissue. Underlying physiopathology is not well unserstood and there is no standart guideline for its management. However, after the demarcation of necrosis, debridement and for large wounds reconstruction is mandatory. Even though vast majority of the Nicolau syndrome cases were reported by other disciplines but the plastic surgery, there may be further need for reconstructive procedures for wound closure.

Material and Methods: Present study included eight patients admitted to our wound care center for necrosis at the gluteal region after intramuscular injection of diclofenac sodium who were treated with debridement, negative pressure wound therapy and skin grafts. Patients’ ages, genders, body mass indexes, underlying diseases were documented. Sizes of the lesions were measured.  Injection, hospitalization, skin graft operation and discharge dates were recorded.

Results: All the wounds healed uneventfully but with depressed scars. Mean duration of hospitalization was 23.5 (range, 15-34) days.

Conclusion: In the present article, we reported that even if the hospitalization time is longer and cosmetic result is poorer, skin grafting after sufficient times of vacuum assited wound therapy administration is a reliable method. We do not recommend this method as the first choice but if there is not adequate adjacent soft tissue for harvesting  flaps or if a suitable perforator vessel is not found for  peforator flap harvest, this reliable method should be kept in mind.

Anahtar Kelimeler

Nicolau syndrome, Diclofenac; Gluteal defect; Negative pressure wound therapy, Skin graft

Reconstruction of gluteal defects related to Nicolau Syndrome secondary to intramuscular injection of diclofenac sodium with negative pressure wound therapy followed by skin graft

Öz

Kaynakça

• Freudenthal W. Lokales embolisches bismogenol-Exanthem. Arch Dermatol Syph. 1924;147:155-60.
• Nicolau S. Dermite livédoide et gangréneuse de la fesse, consécutive aux injections intra-musculaires, dans la syphilis. Ann mal vénér. 1925;20:321-9.
• 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.
• Kim SK, Kim TH, Lee KC. Nicolau syndrome after intramuscular injection: 3 cases. Arch Plast Surg. 2012;39(3):249-52.
• Noaparast M, Mirsharifi R, Elyasinia F, Parsaei R, Kondori H, Farifteh S. Nicolau syndrome after intramuscular benzathine penicillin injection. Iran J Med Sci. 2014;39(6):577-9.
• Wainstein L, Bernier C, Gerardin M, Bouquie R, Espitia O, Mussini JM, et al. Livedo-like dermatitis and necrotic lesions after high-dose buprenorphine injections: a national French survey. Br J Dermatol. 2015;172(5):1412-4.
• Almudimeegh A, Le Pelletier F, Dupin N. Nicolau syndrome secondary to subcutaneous Bortezomib injection. J Eur Acad Dermatol Venereol. 2016;30(2):348-50.
• Andre P, Haneke E. Nicolau syndrome due to hyaluronic acid injections. J Cosmet Laser Ther. 2016:1-19.
• Seremet S, Turan E, Erdemir AT. Nicolau syndrome following intramuscular injection of oxytocin in pregnant women: report of two cases. Dermatol Online J. 2015;21(8).
• Zecca C, Mainetti C, Blum R, Gobbi C. Recurrent Nicolau syndrome associated with subcutaneous glatiramer acetate injection--a case report. BMC Neurol. 2015;15:249.
• McKinney C, Sharma N, Jerath RS. Livedoid dermatitis (Nicolau syndrome) following intra-articular glucocorticoid injection. J Clin Rheumatol. 2014;20(6):339-40.
• Koklu E, Sarici SU, Altun D, Erdeve O. Nicolau syndrome induced by intramuscular vitamin K in a premature newborn. Eur J Pediatr. 2009;168(12):1541-2.
• Alsuwaidi AR, Albawardi A, Khan NH, Souid AK. A 4-month-old baby presenting with dermal necrotizing granulomatous giant cell reaction at the injection site of 13-valent pneumococcal conjugate vaccine: a case report. J Med Case Rep. 2014;8:285.
• Tierce MLt, Schultz SM, Lanier BQ. Tissue loss with subcutaneous immunotherapy-Nicolau syndrome. J Allergy Clin Immunol Pract. 2016;4(1):154-5.
• Zaragoza J, Delaplace M, Benamara M, Esteve E. [A rare side effect of mesotherapy: Nicolau syndrome]. Ann Dermatol Venereol. 2013;140(11):713-7.
• Korkomaz J, Maatouk I, Moutran R, Helou J. Images in vascular medicine. Nicolau livedoid dermatitis occurring after sclerotherapy. Vasc Med. 2014;19(5):415-6.
• Ezzedine K, Vadoud‐Seyedi J, Heenen M. Nicolau syndrome following diclofenac administration. British journal of dermatology. 2004;150(2):385-6.
• Kocman EA, Yasar FN, Kose AA, Cil Y, Karabagli Y, Cetin C. Freestyle Perforator-Based Fasciocutaneous Flap Reconstruction in Nicolau Syndrome-Related Tissue Necrosis. Indian J Surg. 2015;77(Suppl 3):1187-90.
• Corazza M, Capozzi O, Virgili A. Five cases of livedo‐like dermatitis (Nicolau’s syndrome) due to bismuth salts and various other non‐steroidal anti‐inflammatory drugs. Journal of the European Academy of Dermatology and Venereology. 2001;15(6):585-8.
• Ergul Y, Soydemir D, Tastan Y, Omeroglu RE. Does early hyperbaric oxygen therapy prevent extremity necrosis in Nicolau syndrome? Pediatr Int. 2012;54(3):e15-8.