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Background Necrotizing soft tissue infection (NSTI) is a rare, severe bacterial infection that causes rapidly progressive soft tissue necrosis from the skin to the muscle. The gold standard for treating NSTI is a prompt diagnosis, early surgical debridement of necrotic tissue, and antimicrobial therapy. This study investigated the relationship between the involvement of plastic surgeons and the clinical course of NSTI cases treated at Yokosuka General Hospital Uwamachi. Methodology This study involved 28 patients with NSTI who were treated at Yokosuka General Hospital Uwamachi. Patient background, outcomes (mortality and amputation), and days to the first surgery were compared in the early and nonearly plastic surgery intervention groups. Moreover, the duration of treatment was also compared in surviving patients. Differences between the two groups were analyzed using Fisher's direct probability test, Mann-Whitney U test was used for comparison of continuous variables between the two groups, and Spearman's rank correlation analysis was used for the bivariate correlation coefficient. The significance level was set at <5%. Results There were eight and 20 patients in the early and nonearly plastic surgery intervention groups (14 in later intervention and six in nonintervention), respectively. A difference in the median number of days to the first surgery between the early (zero days) and the nonearly (two days) intervention groups was significant (p = 0.002). In the survival groups, the median treatment duration in the early (n = 8) and nonearly (n = 13) intervention groups was 44 and 82 days, respectively, which was significantly shorter in the early intervention group (p = 0.003). Conclusions The number of days until the first surgery and the length of the treatment period were significantly shorter in the early plastic surgery intervention group than in the nonearly intervention group.
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Necrotizing soft tissue infection (NSTI) is a rare but rapidly progressing soft-tissue infection. Few reports of NSTI caused by colon cancer have been published. We present a rare case of NSTI of the thigh associated the retroperitoneal spread of ascending colon cancer. A 64-year-old man had noticed right hip pain since 3 months before admission, he felt pain in the right thigh which was reddening, and he had difficulty in walking. He was referred to Yokosuka general hospital Uwamachi. Anterolateral aspect of his right thigh was reddening and swelling. The patient was diagnosed with a psoas abscess and a NSTI of the right thigh caused by penetration of ascending colon tumor. The patient underwent debridement of severely necrotized tissue in the right thigh, diverting ileostomy and subsequently a right hemicolectomy with reversal of the ileostomy were performed. He was discharged 70 days after the first surgery. Colon cancer can be a cause of retroperitoneal abscess accompanied by NSTI of the thigh. Two-stage surgery was an efficient option in this patient with NSTI of the thigh associated with locally advanced ascending colon cancer.
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Secondary bone grafting in the alveolar cleft is one of the most important therapeutic modalities for patients with cleft lip and palate. However, in children, harvesting a sufficient amount of bone is difficult, and repeated operations are often required because deformation of the alveolar cleft may occur because of the grafted bone absorption and bone growth, which imposes a heavy burden on the patients. The burden may be reduced if the banking of human bone marrow-derived mesenchymal stem cells (MSCs) could be made possible, that is, if cryopreserved autologous MSCs, those that have been harvested from the patient's own bone marrow, could be cultured and expanded with the patient's own serum and can be thawed and cultivated for grafting at a later date. In the current study, a hybrid-type bone substitute was prepared by thawing and cultivating MSCs that have been cryopreserved for more than 3 months. The hybrid-type bone substitute was implanted subcutaneously in nude mice. At 6 and 9 weeks after grafting, the bone graft was removed, and the osteogenic potential of the cells cultured with autologous serum, as determined by alkaline phosphatase activity and alizarin red S staining, was compared with those cultured with fetal bovine serum. There was no significant difference in the osteogenic potential between MSCs cultured with autologous serum and those cultured with fetal bovine serum. The results suggest the possibility of artificial bone grafting using MSCs cultured with autologous serum and the banking of the cells.