In recent years, the number of patients with diabetes combined with necrotizing fasciitis has increased, so what exactly is necrotizing fasciitis?
Necrotizing fasciitis is a fatal infectious disease that progresses extremely rapidly. It often involves blood vessels, thrombosis, and progressive necrosis of the corresponding skin, subcutaneous tissue, and fascia, spreading along the deep and superficial fascia. Necrotizing fasciitis damages only the subcutaneous tissue and fascia and does not involve the muscle tissue at the site of infection.
Necrotizing fasciitis is more common in the extremities, especially the lower extremities; followed by the perineum, neck, face, abdominal wall, and back and buttocks, and is especially common in patients with diabetes, cardiovascular disease, and kidney disease.
I. Necrotizing fasciitis is divided into two main types.
1, necrotizing fasciitis type I: a variety of bacterial mixed infections, including G+ hemolytic streptococci, Staphylococcus aureus, Clostridium perfringens, Vibrio traumaticus, Bacteroides fragilis and anaerobic bacteria.
2, necrotizing fasciitis type II: multiple β-hemolytic streptococcal infection, often accompanied by shock and multi-organ failure, the mortality rate is extremely high.
Second, the staging of necrotizing fasciitis.
1, early: painful red swelling (redness, swelling, heat, pain, hardness, swelling , erythema, unclear borders may be accompanied by flu symptoms)
2, medium-term: more extensive infection (bright red, light purple swelling, blisters increase, become larger, pain and swelling increased, more severe systemic symptoms)
3.Late stage: persistent high fever, shock 4.End stage: multi-organ failure
4.End stage: multiple organ failure
In life, patients with diabetes, cardiovascular disease and kidney disease should pay special attention to their own situation, especially small wounds, once found to take standardized treatment.
Real case.
Name: Li, male, 36 years old
Date: Admitted 2013-03-25;Discharged 2013-04-26 Hospitalized for 32 days Complaint of left foot rupture for 6 days, blood sugar elevation found for 6 days
Physical examination: 39.9℃, blood pressure 95/50mmHg. delirious state. Swelling and redness of the left lower extremity below the knee joint were obvious, and the left dorsal foot had a medial diameter
About 1.5cm rupture, about 8cm×5cm rupture on the lateral side, tendon exposed, large amount of purulent secretion exuding inside, malodor obvious.
Ancillary examination.
Routine blood WBC 22.3×109/L, N76.5%, Lc14.1%, HbA1c7.9%
Biochemical albumin 26g/L, CRP 123.8mg/L, glucose 11.8mmol/L
Blood sedimentation 88mm/h
Coagulation fibrinogen 5.8g/L, INR1.24, prothrombin time 14.4s
ECG sinus rhythm, HR 86 beats/min, normal range ECG
Foot x-ray left ankle joint and soft tissue around the tarsus were obviously swollen, no obvious bone abnormalities were seen in the left ankle joint and left foot bones
B ultrasound left calf posterior edge subcutaneous edema
Ultrasound heart chambers of normal size and normal cardiac function
Admission diagnosis.
1, diabetes combined with necrotizing fasciitis of the lower limbs
2, sepsis 3, pre-shock
4, hypoproteinemia
5, anemia
6, electrolyte disorders: hypokalemia, hyponatremia
Treatment options.
1, cardiac monitoring, oxygen, arteriovenous puncture placement anti-shock
2, anti-infection (vancomycin, meropenem, fluconazole)
3, blood transfusion, correction of hypoproteinemia, nutritional support
4.Anticoagulation, maintenance of water-electrolyte balance
5.In the afternoon of the day of admission, the vital signs were stable, and surgical debridement was performed.
6.The wound recovered well later