Fasciitis necrotisans – duplicitas casuum

Česká verze

Authors: L. Klein ^1,2; R. Fabian ³; P. Šafránek ⁴; P. Paterová ⁵; I. Slaninka ¹; E. Havel ⁴; P. Dostál ⁶; M. Serbák ⁷
Authors place of work: Oddělení plastické chirurgie a léčby popálenin chirurgické kliniky Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové ¹; Katedra vojenské chirurgie, Fakulta vojenského zdravotnictví Univerzity obrany, Hradec Králové ²; Anesteziologicko-resuscitační oddělení Nemocnice Na Homolce, Praha ³; Jednotka intenzivní péče chirurgické kliniky Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové ⁴; Ústav klinické mikrobiologie Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové ⁵; Klinika anesteziologie, resuscitace a intenzivní medicíny Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové ⁶; Chirurgické oddělení, Litomyšlská nemocnice, Litomyšl ⁷
Published in the journal: Rozhl. Chir., 2018, roč. 97, č. 9, s. 432-441.
Category: Kazuistika

Summary

Necrotizing fasciitis is a dangerous bacterial infectious disease that is not commonplace in Czech society. On the other hand, neither is it so rare that the majority of surgeons should not come across it occasionally. In the early stages, pathological changes in fascia, subcutaneous tissue and even skin may run an inconspicuous course. However, this can rapidly deteriorate into shock and sepsis which may lead to multi-organ failure and an imminent life-threatening condition. The fatality rate of necrotizing fasciitis among high-risk groups (e.g. diabetics, patients who are immuno-compromised, obese and/or elderly, malnourished, or with a history of drug use), is particularly steep, reaching as high as 73%. Treatment for this condition consists of early, radical surgical intervention in conjunction with targeted antibiotherapy. Complex resuscitative and intensive care, including rehabilitation, are standard components of post-surgical management. Use of hyperbaric oxygen therapy, if such an opportunity exists, is also recommended. Interdisciplinary collaboration is a vital prerequisite for successful treatment. This article describes two case-studies of necrotizing fasciitis that occurred in men of similar age during a three-year period. Both patients presented with very similar and complicated disease courses, and both were successfully treated by the same interdisciplinary team comprised of clinicians from various specialized departments.

Key words:

necrotizing fasciitis − radical necrectomy – antibiotherapy − hyperbaric oxygen therapy − complex resuscitative and intensive care

Zdroje

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