Necrotizing fasciitis of the chest wall: our preliminary results on the 14 observations treated by negative pressure
Journal Title: JOURNAL OF FUNCTIONAL VENTILATION AND PULMONOLOGY - Year 2018, Vol 9, Issue 27
Abstract
Background. We describe the clinical aspects and surgical management of soft tissue infections with a three-step procedure: antibiotherapy-debridement, negative pressure aspirating dressing. Method. A retrospective case series of fourteen patients with necrositing fasciitis and myonecrosis of the chest wall who underwent operated at the unit of thoracic surgery of the University Hospital of Tananarive, Madagascar between January and December 2016. Results. There are 8 men and 6 women (sex ratio = 1.33). The average age was 31.21 years old. We recorded 4 cases (28.57%) of myonecrosis and 10 cases (71.42%) of necrotizing fasciitis. The average diagnostic delay before surgical management of patients was 22.92 days with a standard deviation of 12.16. The clinic is dominated by infectious syndrome and deterioration of general status in 100% and 85.71%, respectively. The lesions of necrotizing fasciitis are associated in 35.71% of cases with cervico-mediastinitis, 4 cases (28.57%) accompanied by cervical cellulitis and 2 cases (14.28%) are associated with a thoracic empyema. Intraoperative bacteriological specimens identified polymicrobial germs with an average of 3.85 microorganisms per patient (Staphylococcus Aureus in 57.14% and Pseudomonas Aeruginosa in 42.85%) mean length of hospital stay was 15.35 days with extremes ranging from 8 to 30 days The operative course was marked by a favorable evolution in 57.14% of cases Six deaths in the first 30 days after surgery were noted following septic shock (5 cases or 35.71%) and cardiogenic shock (1 case or 7.14%). Conclusion. The three pillars, which guarantee the favorable evolution of this devastating affection, consist of an adequate medical reanimation, an appropriate antibiotherapy and an aggressive debridement surgical. Negative pressure therapy allowed us to achieve a good result while avoiding a major reconstructive surgery of the chest wall.
Authors and Affiliations
Narindra Njarasoa Mihaja RAZAFIMANJATO
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- EP ID EP570010
- DOI 10.12699/jfvpulm.9.27.2018.23
- Views 70
- Downloads 0
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