2007, Number 4
Rev Mex Cir Pediatr 2007; 14 (4)
Fasitis Necrotizing a challenge for the Pediatric Surgeon
Rodríguez-Franco E, Gómez-Gutiérrez SR, Aguirre-Jáuregui Ó, Yanowsky-Reyes G, García-García ML, Gómez-Gutiérrez SR
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Language: Spanish
References: 7
Page: 156-164
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ABSTRACT
Introduction: Thebe are many references to this entity since ancient times in descriptions by Hippocrates, Galen and Avicenna, in 1871 during the U.S. civil war, the Army surgeon Joseph Jones made the first detailed reference and designated as “gangrene hospital. B Wilson in 1952 coined the term necrotizing fasciitis and gave the concept so far, which include infections caused by aerobic and anaerobic bacteria. The purpose of this paper is to show our experience in the management of three cases of necrotizing fasciitis.Presentation of Cases: Case 1. A female patient, six years of age with cleft injury erythematous area of 10 cm in diameter with very offensive purulent discharge and remnants of necrotic skin. Treatment with antibiotics is wide spectrum, performing a wide debridement, tissue samples are cultured, cleaning is done every third day surgery and a colostomy performed. To protect using a simple pasta (made from zinc oxide, vegetable oil and white petrolatum) showing marked improvement with adequate granulation tissue and partial recovery. Later followed a skin flap to close the defect. Case 2. Women’s two years of age, undergoes appendectomy in perforated stage, presenting multiple adhesions loop-handle and handle-wall, resulting in ileum, two months after reinstalling the intestine, but 24 hours later, fever, surgical wound Mild erythema and edema with areas of necrosis around the wound. Debridement was performed in the area on five centimeters above the free edge, but in spite of established ongoing progress management of necrosis up to the anterior axillary line, midline abdominal, lower costal margin, groin and left labia majora. In a span of 48 hrs. requires early surgical debridement and cleaning, making the diagnosis of necrotizing fasciitis. For the three months die from septic shock refractory to therapeutic measures. Case 3. Male patient, two years old, which presents varicella vesicular lesions on the face, trunk and pelvis. It adds abdominal pain, injuries and generalized increase in temperature. Testicular level in their region and penis becomes less necrosis and edema. Requires debridement with exposure of the testicles, the penis, groin and lower back. The patient had granulation tissue free of infection, finally placed grafts and the patient is discharged.
Discussion: We have an entity with high mortality, its sudden onset sporadic and requires us to disclose it and understand it, especially the pediatric surgeon and that plays a key role in the detection and timely management of this disease. It is important to determine whether it is a localized infection of skin and subcutaneous tissue superficial, or if it involves deeper layers. The presence of malaise and pain disproportionate to local signs to suspect necrotizing fasciitis to which must be taken aggressive surgical treatment.
REFERENCES
Acute Appendicitis With Fulminant Necrotizing Fascitis in a Neonate. By Abhay Lodha, Paul W. Wales, and cols. From the Divisions of Neonatology, General Surgery and Pathology, Hospital for Sick Children and University of Toronto, Ontario, Canada. Journal of Pediatric Surgery, Vol 38, No 11 ( November), 2003: 5,6