Patient: Doctor, my leg is suddenly swollen and painful, ** it is hot to the touch, and it hurts when I touch it, what's going on?
At this time, be wary of 2 common situations:1deep tissue infection; 2.Deep vein thrombosis of the lower extremities.
Today we will first talk about deep tissue infection - necrotizing fasciitis!
Necrotizing fasciitisNecrotizing fasciitis (NF) is a rapidly progressive and critical soft-tissue infection characterized by extensive necrosis of the fascia and subcutaneous tissues, eventually leading to severe systemic toxicity. Its essence is an infection caused by the invasion of pathogenic bacteria into deep tissues, and according to statistics, the incidence of the disease is only 03,1510,000 people, but their mortality rate is as high as 15 per cent to 29 per cent. The reason for such a high mortality rate is related to the rapid progression of the disease and the fact that its early symptoms are not noticeable.
Common pathogenic bacteria in NF include streptococcus, Staphylococcus aureus, etc. Most common pathogenic bacteria do not cause inflammatory infections under physiological circumstances, but driven by various risk factors, once the occurrence of **, digestive tract and other tissues caused by external invasion caused by damage, it will produce strong toxicity and cause serious local or systemic infection.
1.2 Predisposing factors
At present, it has been found that your predisposing factors include: diabetes, chronic diseases such as liver and kidney, autoimmune diseases and immunosuppressive drugs (prednisolone, etc.), tumors, human immunodeficiency virus (HIV) infection, ulcers, malnutrition, obesity, trauma from major surgery, burns, lacerations and trauma caused by **biopsy, etc.
2 Clinical features of necrotizing fasciitis
Patients with NF often present with elevated skin temperature, ecchymosis, fever, and soft-tissue edema, which may be accompanied by extreme pain and may eventually progress to local tissue necrosis. The most typical manifestations are superficial erythema, edema, pain, and elevated skin temperature. When the infection is advanced, injuries such as bullae and blisters occur.
3.Clinical diagnosis.
3.1 Laboratory tests
Due to the atypical nature of early clinical manifestations and the lack of definitive diagnostic methods, early and timely diagnosis can be assisted by laboratory indicators, including total serum leukocytes, C-reactive protein, metabolic indicators, coagulation curves, creatine kinase, creatinine, etc.
3.2 Imaging tests
CT is currently the imaging modality of choice. Another benefit of CT is that non-radiology clinicians can quickly assess CT before a formal imaging report is available. Ultrasonography can also aid in diagnosis, but for low-risk patients, point-of-care ultrasonography provides mostly diagnostic reports that are not related to the disease and are less accurate than CT. Until now, surgical exploration has remained the gold standard for diagnosing necrotizing fasciitis.
4 ** Principle
Early diagnosis, early debridement, correction of shock and multi-organ damage, plenty of effective antibiotics and systemic support**!
4.1 Antimicrobial**
Typically, empiric antibiotics** require broad coverage of aerobic and anaerobe, such as piperacillin, tazobactam, or carbapenems (e.g., meropenem, imipenem, etc.), before determining the type of pathogen and antibiotic susceptibility. Clindamycin is also used symptomatic because it has an effect on toxins released by certain organisms (Staphylococcus aureus, etc.).
4.2 Surgical debridement
Surgery is the most important procedure after necrotizing fasciitis is suspected or diagnosed, and the affected tissue should be promptly surgically explored and debrided. After the initial extensive debridement, continuous debridement should be performed daily until it is determined that all necrotic tissue has been removed. Early surgical intervention can improve survival, and the earlier the surgical intervention, the better the patient prognosis.
4.3 Postoperative drainage
In addition to intraoperative debridement, vacuum sealing drainage (VSD) also has a good effect on the drainage effect of postoperative wounds in infected patients. VSD uses external negative pressure suction to produce a pressure difference between the inside and outside of the wound, which promotes blood perfusion in the wound, improves the oxygen of the blood vessels at the wound site, is conducive to the proliferation of new cells, promotes the growth of granulation tissue, and shortens the healing time of the wound. VSD can increase wound healing rates by 61% and significantly reduce postoperative** costs. Postoperative negative pressure drainage** can also greatly reduce the incidence of infectious complications and reduce patient suffering, and VSD has obvious advantages for the prognosis of patients compared with traditional daily postoperative dressing changes.
Although progress has been made in recent years in the pathogenesis, clinical manifestations, diagnosis and ** of necrotizing fasciitis, necrotizing fasciitis still has a high amputation rate and mortality. Clinical symptoms and a high level of suspicion for necrotizing fasciitis are sufficient to raise awareness and thus improve the quality of the patient's prognosis.