Masivni nekrotizujući fasciitis posle hirurškog zahvata na arteriji potkolenice – terapijski izazov

  • Petar Popov Vascular Surgery Clinic, Dedinje Cardiovascular Institute, Belgrade, Serbia; Faculty of Medicine University of Belgrade, Belgrade, Serbia
  • Slobodan Tanasković Vascular Surgery Clinic, Dedinje Cardiovascular Institute, Belgrade, Serbia
  • Vuk Sotirović Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
  • Dragoslav Nenezić Vascular Surgery Clinic, Dedinje Cardiovascular Institute, Belgrade, Serbia; Faculty of Medicine University of Belgrade, Belgrade, Serbia
  • Djordje Radak Vascular Surgery Clinic, Dedinje Cardiovascular Institute, Belgrade, Serbia; Faculty of Medicine University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/4427
Ključne reči: vascular surgical procedures||, ||hirurgija, vaskularna, procedure, treatment outcome||, ||lečenje, ishod, fasciitis, necrotizing||, ||fasciitis, nekrotizujući, anti-bacterial agents||, ||antibiotici,

Sažetak


Uvod. Nekrotizujući fasciitis je retka, progresivna bakterijska infekcija površinske fascije, praćena sekundarnom nekrozom potkožnog tkiva. Prikazali smo bolesnika primljenog radi famorodistalne rekonstrukcije venskim graftom, koja je u neposrednom postoperativnom toku bila komplikovana fulminantnim, nekrotizirajućim faciitisom. Bolesnik je uspešno tretiran ekstenzivnim, dnevnim debridmanom inficirane rane uz parenteralnu primenu antibiotika širokog spektra. Lečenje je završeno uspešnom rekonstrukcijom kože Tiršovim graftom. Prikaz bolesnika. Bolesnik, star 61 godinu, primljen je radi planirane hirurške revaskularizacije venskim femoropoplitealnim bypass-om. Žalio se na intermitentnu klaudikaciju u levoj nozi, posle pređenih 50 metara. Brahijalni indeks gležnja iznosio je 0.45 levo i 1.0 desno. Drugog dana po rekonstrukciji pojavili su se prvi znaci infekcije kože na mesu salenektomije, uz ubrzano širenje na dublja tkiva i mišiće cele noge praćeno sistemskim znacima sepse. Ukupno 33 dana primarna terapija bila je hirurška debridman rane podržan parenteralnom primenom antibiotika. Bris rane uziman je na drugi dan i konstantno je bio sterilan. Sticanjem adekvatnih uslova urađena je rekonstrukcija kože Tiršovom metodom. Zaključak. Hitan opsežan hirurški debridman uz adekvatnu primena antibiotika dali su zadovoljavajuće rezultate. Samo bris rane nije uvek pouzdan indikator prisustva infekcije. Kliničko iskustvo hirurga i lokalni status rane ključni su faktori uspeha.

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Objavljeno
2015/07/08
Broj časopisa
Vol. 72 Br. 5 (2015)
Rubrika
Prikaz bolesnika