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Federación Mexicana de Ginecología y Obstetricia, A.C.

2018, Number 08

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Ginecol Obstet Mex 2018; 86 (08)

Necrotizing fasciitis in the surgical wound. A case report

Frías-Sánchez Z, Pantoja-Garrido M, Pantoja-Rosso FJ, Vico-de Miguel FJ

Language: Spanish
References: 16
Page: 554-559
PDF size: 332.70 Kb.


ABSTRACT

Background: Necrotizing fasciitis is a rare soft tissue infection, distinguised by an aggressive and rapidly expanding infectious process, that it results in necrosis of the skin, subcutaneous cellular tissue and muscular fascia.
Clinical case: A 25 years-old patient, with 41 weeks of pregnancy; entered the hospital due to delivery labor. Despite the good evolution of the dilation cervical, the pregnancy was completed by caesarean section. During the postoperative were observed signs of moderate anemia; iron and vitamin C were indicated orally; however, on the third postoperative day, the surgical wound with signs was evidenced of intense inflammation and serous exudate. Observed fever of 38.1 ºC in the last hours; his general condition worsened significantly. Laboratory studies reported: leukocytosis, severe anemia, thrombocytopenia, hyponatremia, hyperglycemia, acidosis compensated metabolism and hypoxemia. The culture of exudate from a surgical wound confirmed an infection by Pseudomonas aeruginosa and Staphylococcus aureus. We established the diagnosis of necrotizing fasciitis. The treatment consisted of reopening of the wound, asepsis and debridement of the skin, subcutaneous cellular tissue and fascia muscular. The patient stayed five more days in the intensive care unit, with complementary oxygen, inotropic support, intravenous antibiotics (imipenem, clindamycin, amikacin) and parenteral nutrition. The evolution was favorable; do not observed complications and the surgical wound closed completely.
Conclusions: The prognosis of patients with necrotizing fasciitis varies according of timely diagnosis and treatment. The morbimortality rate it is estimated, even, at 76%.


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