Burak DEMİRAĞ, Ali Onur TİRELİOĞLU, Bartu SARISÖZEN, Kemal DURAK

Bacakta diyabetik yaralara bağlı nekrozitan fasiit

Amaç: Bacaktaki diyabetik yaralara bağlı gelişen nekrozitan fasiit (NF) nedeniyle tedavi edilen hastalar retrospektif olarak incelendi. Çalışma planı: Çalışmaya bacağında diyabetik yaralara bağlı olarak NF gelişen 16 hasta (11 erkek, 5 kadın; ort. yaş 63; dağılım 50-82) alındı. Ek olarak, üç hastada koroner arter hastalığı, üç hastada ise diyabetik nefropatiye bağlı kronik böbrek yetmezliği vardı. Tüm hastalar fizik muayene, laboratuvar bulguları, direkt grafiler, kan basıncı, alınan kültür sonuçları, uygulanan tedaviler ve sonuçları açısından değerlendirildi. Hastaların hastanede kalış süresi ortalaması 26 gündü (dağılım 5-59 gün). Sonuçlar: Dört hastada NF bacakla sınırlıyken, 10 hastada fasiit uyluğa uzanmıştı. İki olguda iki taraflı bacak tutulumu vardı. On bir hastada (%68.8) ağrı yakınması vardı. On dört hastada (%87.5) kretin kinaz değerinde artış görüldü. Direkt grafilerde yedi hastada (%43.8) yumuşak dokuda gaz görüldü. İlk cerrahi müdahale sırasında alınan kültürlerde dört hastada (%25) bir mikroorganizma, beş hastada (%31.3) ise birden fazla mikroorganizma üredi. İzole edilen 17 mikro-organizmanın l O'u (%58.8) enterobakter ailesinden idi. On bir hastaya (%68.8) dizüstü, üç hastaya (%18.8) dizaltı amputasyon yapıldı. Dört hastada ilk tedavi olarak kalça dezartikülasyonu uygulandı. İlk cerrahi girişimlerinden sonra ortalama beş kez (dağılım 2-21) debridman yapıldı. Dokuz hastada septik şok gelişti. Çoklu organ yetmezliği gelişen yedi hasta (%43.8) kaybedildi. Ölen hastalarda kreatin kinaz düzeyleri diğer hastalara göre anlamlı derecede yüksek bulundu (p

Anahtar Kelimeler:

Ekstremiteler, Debridman, Diabetes mellitus, Fasiit, nekrotize, Sağkalım oranı, Fasya

Necrotizing fasciitis in the lower extremity secondary to diabetic wounds

Objectives: The aim of this retrospective study was to evaluate patients who developed necrotizing fasciitis (NF) in the lower extremity secondary to diabetic wounds. Methods: The study included sixteen patients (11 men, 5 women; mean age 63 years; range 50 to 82 years) who were treated for NF arising from diabetic wounds. Associated diseases were coronary heart disease in three patients, and chronic renal failure due to diabetic nephropathy in three patients. The patients were evaluated by physical examination, direct radiographs, blood pressure measurements, and cultures, and with respect to treatment methods and results. The mean hospitalization period was 26 days (range 5 to 59 days). Results: Necrotizing fasciitis was confined to the leg in four patients, extended to the thigh in 10 patients, and was bilateral in two patients. Pain was encountered in 10 patients (68.8%). Fourteen patients (87.5%) had increased creatine kinase levels. Direct radiographs showed gas appearance in soft tissues in seven patients (43.8%). Cultures showed a sin-gle microorganism in four patients (25%), and multiple microorganisms in five patients (31.3%). Of seventeen microorganisms isolated, 10 (58.8%) were Enterobacter species. Eleven patients (68.8%) underwent above-the-knee, and three patients (18.8%) underwent below-the-knee amputations. Disarticulation of the hip was performed in four patients. The mean number of debridements was five (range 2 to 21) following the initial surgical intervention. Nine patients developed septic shock. Seven patients (43.8%) died due to multiple organ failure. Increased creatine kinase levels were significantly associated with mortality (p<0.05). Conclusion: Early and accurate diagnosis and prompt surgical treatment may be life-saving in diabetic patients with NF of the lower extremity.

Keywords:

Extremities, Debridement, Diabetes Mellitus, Fasciitis, Necrotizing, Survival Rate, Fascia,

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