Novosti
Khirurgii

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Year 2022 Vol. 30 No 1

EXCHANGE OF EXPERIENCE

K.V. LIPATOV 1, A.G. ASATRYAN 2, G.G. MELKONYAN 2, V.A. KUZNETSOV 1, I.V. GORBACHEVA 1, M.V. YURCHENKO 2

NECROTISING FASCIITIS OF UPPER LIMB: CLINIC, DIAGNOSIS, TREATMENT

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow,
4th Moscow Clinical Hospital, Moscow, Russian Federation

Objective. To study the treatment results of patients with necrotizing fasciitis (NF) of the upper limb.
Methods. The authors’ observations of 9 patients with a rare and severe disease: necrotizing fasciitis (NF) of the upper limb have been analyzed. Minor skin lesions in the area of the hand became the entry gate for any infection. The median time prior hospitalization was 4,8±1,8 (M±σ) days. Immediately upon admission, the diagnosis of upper limb NF was established in 5 patients. This was followed by emergency radical surgery. The rest were also urgently operated on, but with a diagnosis of phlegmon of the hand and in insufficient volume. They were diagnosed with NF within the first day and a second operation was performed. In most cases the lesion included tissues of the hand, forearm, and arm. Primary surgery was supplemented by staged necrectomies, the number of which averaged 4,7±1,9 per patient. The complex of intensive treatment included broad-spectrum antibiotics, anticoagulants (enoxaparin 8,000 anti-Xa IU / day). Surgical closure of postnecrectomic wounds was performed using skin plastic operations: plastics with local tissues, autodermoplasty with a split graft.
Results. Most of the cases were classified as type II NF (Streptococcus pyogenes or Staphylococcus aureus). In one case, a very rare and extremely severe, NF caused by Pasteurella multocida was observed. No antibiotic-resistant strains were found. Emergency radical operation became the cornerstone of success. The need for staged necrectomy was determined by the formation of secondary necrosis in connection with severe microcirculation disorders. Extensive postnecrectomic wounds were closed after the inflammation subsided with the help of skin plastic operations. The average duration of inpatient treatment was 20,8±6,2 days. There were no lethal outcomes.
Conclusion. A complex approach to the treatment of necrotising fasciitis of upper limb allowed getting positive treatment results in all cases.

Keywords: upper limb necrotizing fasciitis, necrotizing soft tissue infection, Streptococcus pyogenes, Pasteurella multocida, surgical treatment
p. 102-111 of the original issue
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Address for correspondence:
119991, Russian Federation,
Moscow, Bolshaya Pirogovskaya Str., 2-4,
I.M. Sechenov First Moscow
State Medical University,
General Surgery Department ,
tel. mobile: +7 (916) 635-89-88,
e-mail: k_lipatov@mail.ru,
Lipatov KonstantinV.
Information about the authors:
Lipatov Konstantin V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow of the Ministry of Health of Russia, Russian Federation.
http://orcid.org/0000-0002-9902-2650
Asatryan Artur G., PhD, Head of the Purulent Surgery Department, the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0002-8409-2605
Melkonyan George G., MD, Professor, Chief Physician, the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0001-7234-4185
Kuznetsov Vladimir A., Student, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia,, Moscow, Russian Federation.
http://orcid.org/0000-0001-8385-4113
Gorbacheva Irina V., PhD, Associate Professor of the General Surgery Department , I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow, Russian Federation.
http://orcid.org/0000-0002-1060-1163
Yurchenko Mark V., Surgeon, the Purulent Surgery Department, the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0002-4059-7548
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