Novosti
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This journal is indexed in Scopus |
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Year 2019 Vol. 27 No 6
CASE REPORTS
K.V. LIPATOV 1, V.K. GOSTISHCHEV 1, A.G. ASATRYAN 1, G.G. MELKONYAN 3, A.V. KIRILLIN 2, I.V. GORBACHEVA 1, E.S. SOLODOVNIKOV 1
SURGICAL TREATMENT OF THE LOWER EXTREMITY EXTENSIVE PURULENT AND NECROTIC SOFT TISSUE LESIONS IN A PATIENT WITH SYSTEMIC SCLERODERMA
I.M. Sechenov First Moscow State Medical University 1,
I.V. Davidovsky Moscow Clinical Hospital 2,
The 4th Moscow Clinical Hospital 3, Moscow,
The Russian Federation
Systemic scleroderma is an autoimmune condition that is characterized by fibrosis of the skin and visceral organs. Microangiopathy, which is one of the key features of systemic scleroderma, is one of the causes of formation of skin necrosis and ulcers. Widespread suppurative necrotic inflammation of integumentary tissues is quite rare in systemic scleroderma, but it creates significant complications in treatment of the disease. This observation presents the experience of surgical treatment of a patient with extensive suppurative necrotic inflammation of the soft tissues of the lower limb with systemic scleroderma as an underlying disease for which she received immunosuppressive medications. The disease was marked by fast progression and was accompanied by progressive necrosis of the skin and subcutaneous adipose tissue. The signs of systemic inflammation were diagnosed. Emergency surgical debridement was performed with subsequent necrectomyies on the 2, 5, 7, 9 and 15th days of hospitalization. The pathogens isolated from the wound were Staphylococcus aureus, Streptococcus pyogenes. Additionally to the surgical treatment, complex pharmacological therapy, including antimicrobial, detoxification, vascular and immunotherapy, was carried out. This complex treatment led to the wound cleaning and regression of inflammation by the 20th day of hospitalization. Autologous skin grafting was later performed with no complications after a year of follow-up. This case report illustrates a severe bacterial soft tissue infection in a patient with a diffuse form of systemic scleroderma against the background of immunosuppression caused by chemotherapy and glucocorticoids. This complex treatment allowed us eliminating the infection and performing the autologous skin grafting with the extensive wound closure.
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119991, The 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
Konstantin V. Lipatov
Lipatov Konstantin V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-9902-2650
Gostishchev Victor K., MD, Professor, Academician of RAS, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-8140-7931
Asatryan Artur G., PhD, Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-8409-2605
Melkonyan George G., MD, Professor, Head Physician of the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0001-7234-4185
Kirillin Alexey V., PhD, Deputy Head Physician for Surgery, I.V. Davidovsky Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0003-0585-9941
Gorbacheva Irina V., PhD, Associate Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-1060-1163
Solodovnikov Egor S., 4th year student, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-7006-6641
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