NECROTISING FASCIITIS OF UPPER LIMB: CLINIC, DIAGNOSIS, TREATMENT

Abstract

Objective. To study the treatment results of patients with necrotizing fasciitis (NF) of the upper limb. Methods. The authors’ observations of 9 patients with a rare and severe disease: necrotizing fasciitis (NF) of the upper limb have been analyzed. Minor skin lesions in the area of the hand became the entry gate for any infection. The median time prior hospitalization was 4,8±1,8 (M±σ) days. Immediately upon admission, the diagnosis of upper limb NF was established in 5 patients. This was followed by emergency radical surgery. The rest were also urgently operated on, but with a diagnosis of phlegmon of the hand and in insufficient volume. They were diagnosed with NF within the first day and a second operation was performed. In most cases the lesion included tissues of the hand, forearm, and arm. Primary surgery was supplemented by staged necrectomies, the number of which averaged 4,7±1,9 per patient. The complex of intensive treatment included broad-spectrum antibiotics, anticoagulants (enoxaparin 8,000 anti-Xa IU / day). Surgical closure of postnecrectomic wounds was performed using skin plastic operations: plastics with local tissues, autodermoplasty with a split graft. Results. Most of the cases were classified as type II NF (Streptococcus pyogenes or Staphylococcus aureus). In one case, a very rare and extremely severe, NF caused by Pasteurella multocida was observed. No antibiotic-resistant strains were found. Emergency radical operation became the cornerstone of success. The need for staged necrectomy was determined by the formation of secondary necrosis in connection with severe microcirculation disorders. Extensive postnecrectomic wounds were closed after the inflammation subsided with the help of skin plastic operations. The average duration of inpatient treatment was 20,8±6,2 days. There were no lethal outcomes. Conclusion. A complex approach to the treatment of necrotising fasciitis of upper limb allowed getting positive treatment results in all cases.