Mustafa DURGUN, H. Rıfat ÖZAKPINAR, Ali Teoman TELLİOĞLU, Suna DURGUN ÖĞÜCÜ, A. Avni Tolga ERYILMAZ, H. Fatih ÖKTEM

Diyabetik hastaların alt ekstremitelerinde gelişen nekrotizan fasiit: Derleme ve iki olgu sunumu

Nekrotizan fasiit, aerobik ve anaerobik çok sayıda bakterinin sebep olduğu, yüzeyel fasya ve cilt altı yağ dokusunun etkilendiği nekrotizan yumuşak doku enfeksiyonları olarak tanımlanmaktadır. Nekrotizan fasiit gelişimine yatkınlık oluşturan faktörler başta diyabet olmak üzere obezite, ileri yaş, sigara, alkol, malignite, vasküler hastalıklar, kronik kalp ve akciğer hastalıkları, intravenöz ilaç bağımlılığı ve steroid kullanımı olarak sayılabilir. Özellikle diyabetik hastalarda gelişen nekrotizan fasiit yüksek mortalite ile seyredebilmektedir. Bu hastalarda semptomlar normal hastalara göre farklı olabileceğinden tanıda gecikmeler olmakta, erken cerrahi debridman yapılamamakta ve hasta kaybedilebilmektedir. Bu yazıda kliniğimizde yakın dönemde takip ettiğimiz, alt ekstremitelerinde nekrotizan fasiit gelişmiş 2 diyabetik hastayı sunmayı ve literatürü gözden geçirerek risk faktörleri, etiyoloji, teşhis ve tedaviyi tartışmayı amaçladık.

Necrotizing fasciitis in the lower extremities of diabetic patients: A review and report of two cases

Necrotizing fascitis are defined as soft tissue infections in which superficial fascia and subcutaneous fatty tissue are affected. It is caused by numerous aerobic and anaerobic bacteria. Such factors as diabetes, obesity, advanced age, smoking, alcohol, malignancy; vascular diseases, chronic heart and pulmonary diseases, intravenous drug addiction, and steroid use lead to predilection. The mortality rate due to necrotizing fascitis in diabetic patients in particular may be high. In such patients, symptoms may be different from those of normal patients; thus, diagnosis may be delayed, resulting in delayed surgical intervention and mortality. Here we present 2 diabetic patients with necrotizing fascitis in the lower extremities that were recently followed-up in our department and to discuss risk factors, etiology, diagnosis, and treatment in the light of relevant literature.

PDF

___

1. Fink, A., DeLuca, G. Necrotizing fasciitis: Pathophysiology and treatment. Dermatology Nursing. 2002; 14, 324–7.
2. Green, R. J. Necrotising fasciitis. Chest. 1996; 110, 219–29. 3. Kotrappa, K. S., Bansal, R. S., Amin, N. M. Necrotizing fasciitis. American Family Physician. 1996; 53, 1691– 6.
3. Meltzer, D. L., & Kabongo, M. Necrotizing fasciitis: A diagnostic challenge. American Family Physician. 1997; 56,145–9.
4. Ward, R. G., & Walsh, M. S. Necrotizing fasciitis: 10 year’ experience in a district general hospital. British Journal of Surgery. 1991; 78, 488– 9.
5. Robertson HD, Polk HC Jr. The mechanism of infection in patients with diabetes mellitus: a review of leukocyte malfunction. Surgery. 1974;75:123-8.
6. Francis KR, Lamaute HR, Davis JM, Pizzi WF. Implications of risk factors in necrotizing fasciitis. Am Surg. 1993;59:304-8.
7. Descamps, V., Aitken, J., & Lee, M. G. Hippocrates on necrotising fasciitis. Lancet. 1994; 344, 556.
8. Fournier, J. A. Gangrene foudroyant de la verge. Semaine Media. 1883; 3, 345.
9. Meleney, F. L. Hemolytic Streptococcus gangrene. Archives of Surgery. 1924; 9, 317.
10. . Caruso DM, Foster KN, Chellappan A. Burn center treatment of necrotizing fasciitis, fournier gangrene, and purpura fulminans. Prob Gen Surg. 2003; 20(1): 138-45
11. Andreasen TJ, Green SD, Childers BJ. Massive infec¬tious softtissue injury: Diagnosis and management of ne¬crotizing fasciitis and purpura fulminans. Plast Reconstr Surg. 2001; 107(4): 1025-35.
12. Green RJ, Dafoe CD, Raffin TA. Necrotizing fasciitis. Chest. 1996; 110:219-29
13. Swartz MN. Cellulitis and subcutaneous tissue infections. In: Mandell GL, Bannet JE, Dolin R (eds). Principles and Practice of Infectious Diseases. Philadelphia: Churchill Livingstone. 2005:1172-94
14. Headley AJ. Necrotizing soft tissue infections: a primary care review. Am Fam Physician. 2003; 68:323-8
15. Sutherland ME, Meyer AA. Necrotizing soft tissue infections. Surg Clin North Am. 1994; 74:591-607
16. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005; 41:1373-1406
17. Majeski J, Majeski E. Necrotizing fasciitis: improved sur¬vival with early recognition by tissue biopsy and aggres¬sive surgical treatment. South Med J. 1997; 90(11): 1065
18. Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, Mc- Donald JC. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: A ret¬rospective study. Am Surg. 1998; 64(5): 397-400; dis¬cussion 400-1.