Patients suffering PJI present a certain risk profile with many comorbidities, e.g. high age and obesity. The observed microbiological pattern demonstrates the rise of high-resistance pathogens.
Background and Aims: necrotizing fasciitis (nf) and gas forming myonecrosis (gfm), both being subtypes of necrotizing soft tissue infection (nsti), are life threatening conditions sharing certain similarities. despite the necessity of early and radical surgical debridement in necrotizing infections, the distinction between these entities is of clinical relevance since gas forming myonecrosis in a number of cases results from an underlying abdominal cause and the focus of infection can be missed. this study was to evaluate the incidence and risk factors as well as the mortality rate in patients with nsti and gfm.Material and Methods: all patients with nsti treated in the authors' hospital between January 2005 and december 2009 were enrolled in the study. medical records, histological slides, microbiological and laboratory parameters as well as Computerized tomography (Ct) and magnetic resonance imaging (mri) scans were reviewed for all patients. differences between nf and gfm regarding hospital stay, number of surgical interventions and pre-existing comorbidities as well as mortality rate were analyzed. the laboratory risk factor for necrotizing fasciitis (LrineC) score was calculated in all patients on admission.Results and Conclusions: thirty patients (17 female, 13 male) with necrotizing fasciitis with a mean age of 55 years (sd 15.5) were included in the study. there was no statistically significant difference between survivors and deceased patients comparing the LrineC score (n.s.). patients with necrotizing fasciitis secondarily involving the trunk had a significantly higher mortality rate (or 11.2; 95% Ci = 1.7-72.3). in the majority of cases (12 cases), minor skin lesions were identified as the site of origin. amongst all necrotizing soft tissue infections six patients (female n = 3; male n = 3) with a mean age of 61.5 years (sd 12.2) with non-clostridial gas forming myonecrosis were identified.
The Ilizarov external fixator is a safe method for ankle fusion in cases of infection. The advances are a possible application at acute infection and immediate mobilisation at full weight bearing. However, it remains a time-consuming and stressful procedure for the patient.
The VAC-therapy is a safe, easy, and effective therapy for the management of chronic wounds. Known advantages of the VAC technique are the quicker wound healing by stimulating the blood flow, the formation of granulation tissue, angiogenesis, and cell proliferation. The use of negative pressure treatment can decrease the number of dressing changes and length of hospital stay. However, some related complications after and during VAC therapy have been described. We here describe a rare complication during the treatment of severe os ischium sore with VAC therapy, which has not been reported in the literature yet. We report about a 43-year-old paraplegic patient, referred to our clinic from a regional hospital where he had been admitted 2 months earlier, presenting with a necrotizing fasciitis after VAC therapy during the treatment of fourth grade os ischium sore. After operative debridement and long-term antibiotics with Ciprofloxacin soft tissue closure was performed using a myocutaneous tensor fascia lata flap. Temporary stabilization was achieved by a triangle external fixateur attached to the right femur and the pelvis. After 1 week the tapping point of the muscle flap could be covered with local skin mesh-graft from the right calf as a donor site. The patient was mobilized in a wheelchair and was discharged home 3 months after admission. The VAC technique is a safe, easy, and effective means in chronic wound care management. However, the described rare complication should be kept in mind. The clinical management of VAC therapy requires a distinct indication and close clinical monitoring by experienced medical professionals. The use of VAC therapy in fourth grade sores may have deleterious consequences for the patient.
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