Natkolena amputacija zbog nekrotizujućeg fasciitisa izazvanog sojem Escherichia coli koji produkuje gas i zatvaranje velike otvorene rane uz pomoć terapije negativnim pritiskom

  • Slobodan Pešić General Hospital of Subotica, Department of Surgery/Vascular Surgery Division, Subotica, Serbia
  • Snežana Tulenčić Egić General Hospital of Subotica, Department of Surgery/Vascular Surgery Division, Subotica, Serbia
  • Mihajlo Zwick General Hospital of Subotica, Department of Surgery/Vascular Surgery Division, Subotica, Serbia
DOI: https://doi.org/10.2298/VSP220315074P
Ključne reči: amputacija, hirurška, dijabetes melitus, escherichia coli, fasciitis, nekrotizujući, rana, zatvaranje, tehnike

Sažetak


Uvod. Neklostridijalne infekcije mekih tkiva sa pisustvom gasa (NIMTPG) su retke, rapidno progresivne infekcije, koje se karakterišu visokim mortalitetom i visokom stopom amputacija. U terapiji je ključan hirurški debridman, posle koga ostaju kompleksne rane, koje je potrebno zatvoriti da bi se sprečio sekundarni morbiditet. Prikaz bolesnika. Prikazan je bolesnik sa NIMTPG, dijabetičar, star 68 godina, sa akutnom trombozom aneurizme poplitealne arterije i radiološkim znacima gasa u desnoj nozi i zidu mokraćne bešike. Infekcija je bila izazvana sojem Escherichia coli koji produkuje gas. Bolesnik je u u ranoj fazi lečen antibioticima i amputiran mu je femur. Za zatvaranje amputacione rane primenjeno je vakumom-asistirano zatvaranje (VAZ). Primenjena terapija je dovela do primarnog zatvaranja rane bez komplikacija, 17 dana posle operacije. Zaključak. Negativan pritisak povećava klirens tečnosti i infekcije iz rane, povećava i pritisak u rani, kao i približavanje kožnih „flapova“. Terapija VAZ može biti dobar pomoćni tretman za zatvaranje velikih rana kod bolesnika sa NIMTPG u cilju izbegavanja velikih rekonstruktivnih zahvata.

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Objavljeno
2023/06/30
Broj časopisa
Vol. 80 Br. 06 (2023): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika