Necrotizing fasciitis is a rare infection and often difficult to diagnose early stage, which is associated with systemic toxicity, which has a fulminate course and high mortality rate of about 33-60% (Moss, 1999).The prognosis of - depends on its early recognition and a regime of vigorous resuscitation, nutritional support, broad-spectrum antibiotics and aggressive debridement with a mandatory re-explorations, which are crucial in the treatment of patients. Necrotizing fasciitis is an infection of the superficial fascia and deep soft tissue surrounding the facial cleft between the subcutaneous tissue and the fascia over the muscle, which secondarily affects the skin, respecting the deep fascia and muscle (Eke, 2000).
The etiology is usually poly-microbial; a mixture of aerobic and anaerobic bacteria, only beta-hemolytic streptococcus group A pathogen can be alone, especially in previously healthy young patients with clinical presentation of toxic shock syndrome (Green, 1996). This infection is particularly common in patients with diabetes, decubitus ulcer, drug addicts, alcoholics, or infection of immune compromised patients with multiple trauma heridas.4 are at high risk for nosocomial infection complicated that patients undergoing elective surgery rutina.5 The study Brook et al, 92% of patients had a predisposition or condition associated with: trauma (34%), previous surgery (20%), diabetes mellitus (18%), immunosuppressant (17%). The diagnosis can be established by surgical exploration along the facial plane (Nolan, 1993).
Condition of Necrotizing Fasciitis
Case # 1 The first case of a pediatric patient, male 11 years old, admitted to the emergency by submitting multiple injuries, being hit by moving vehicle (Russell, 2000). Introducing the following blunt abdominal trauma injuries, this required exploratory laparotomy, pelvic trauma oblique fracture of the sacrum. Furthermore tear soft tissue. He was initially treated for his multiple fractures secondary to trauma and debridement's of the wounds was necessary. At 4 days after admission SIRS patient presents with signs of severe necrotizing infection of the dorsal-lumbar region sacro-coccygeal from DIO, groin and face anther-posterior left thigh and posterior lateral side of leg Left.
Case # 2 The second case is a school patient, female sex, 4 years old, admitted to the emergency for introducing poly trauma, being hit by moving vehicle. Introducing moderate TBI, Glasgow 12/15, with a fractured left front. Fracture of left femur and the first metatarsal, fractured left collarbone, but deep wounds with loss of substance.
He was initially treated with debridement and external fixation of the fracture, but flap approach dermograsoso At 4 days after surgery the patient has SIRS, infection and signs of severe necrotizing soft tissue of his left leg. Proceeding to make extensive debridement's skin and subcutaneous tissue and in intensive care management, life support, but broad-spectrum antibiotic s (meropenem).
One problem of severe infections of skin and soft tissue, is that in some cases, the characteristic presentation of a complicated infection [deep tissue infection involving fascia, skeletal muscle, subcutaneous tissue and / or wants major surgery, are more consistent with an uncomplicated infection, resulting in a suboptimal initial treatment.
Early diagnosis of necrotizing fasciitis is often difficult and is critical for pronostic may be established by doing a biopsy of tissue by freezing, for ...