Necrotizing fasciitis: Case report

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Case history: 83 years old, diabetic, 10 days of evolution, pain, swelling and erythema on the right hand. Diagnosed 7 days before with right-hand cellulite. The patient returns due to the worsening of the condition, reporting more pain. Clinical Findings: Cellulitis was found below the right elbow and two plaque necrosis. The patient hand has paresthesia and motor impairment, with marked decrease in peripheral perfusion, with neurological involvement of the radial, median and ulnar nerve. Investigation /Results: Analytically with WBC 25000/L, CRP 26 mg/dL.CT Angiography: gas infiltration at volar and dorsal level of the distal ⅓ of the right forearm, with preserved arterial and venous permeability. Diagnosis: Necrotizing fasciitis in the right upper limb. Therapy and Progression: Decompressive fasciotomy was performed with surgical debridement of an infected site in the deep muscular compartment of the forearm. Multiple surgeries on different days were performed: surgical cleaning of the necrotic tissues; disarticulation of the first finger due to the progression of ischemia; amputation of the proximal 1/3 of the forearm and placed a Solid formulation of antibiotic therapy.Comments: Necrotizing fasciitis is an infection that causes the death of the soft tissues, and it is a severe disease that suddenly appears and has a fast evolution. Tissue findings may include discoloration, gross edema or ecchymosis, and signs of necrosis, thus generating severe pain. Managing requires a rapid diagnosis, immediate aggressive surgical treatment, and an extended debridement. Amputation may be required to handle the infection. Survivors often endure multiple surgeries and prolonged hospitalization and rehabilitation.References(Note:The maximum number of chars are 1800 instead of 2000)

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