Gangrena de Fournier / Fournier's gangrene

Introducción: La gangrena de Fournier es una enfermedad infecciosa caracterizada por una fascitis necrotizante de evolución fulminante que afecta a la región perineal, genital o perianal, con una rápida progresión y alta letalidad. Objetivo: Describir la sintomatología del paciente y buena evolución, a pesar de varios factores de mal pronóstico. Caso clínico: Se trata de un paciente masculino de 77 años de edad, diabético e hipertenso, remitido a cuidados intensivos, desde el servicio de Urología, con el diagnóstico de gangrena de Fournier, descontrol metabólico y agudización de su enfermedad renal crónica. Conclusiones: Con el tratamiento médico quirúrgico intensivo y la utilización de oxigenación hiperbárica, tuvo una evolución favorable, hasta su egreso(AU)

Introduction: Fournier gangrene is an infectious disease characterized by a necrotizing fascitis of fulminant evolution that affects the perineal, genital or perianal region, with rapid progression and high lethality. Objective: To describe the patient symptomatology and good evolution, despite several factors of poor prognosis. Clinical case: 77-year-old male patient, diabetic and hypertensive, referred to intensive care, from the urology department, with the diagnosis of Fournier gangrene, metabolic decontrol and exacerbation of chronic kidney disease. Conclusions: With intensive surgical and medical treatment and the use of hyperbaric oxygenation, he had a favorable evolution, until his discharge(AU)

Reconstrução de parede abdominal: série de casos / Reconstruction of the abdominal wall: a case series

Introdução: Os pacientes com defeitos de parede abdominal chegam ao consultório do cirurgião plástico em situações muitas vezes complexas, necessitando de abordagem cirúrgica avançada. Métodos: Estudo primário, retrospectivo e descritivo de pacientes submetidos a procedimentos cirúrgicos de reconstrução de parede abdominal pelo Serviço de Cirurgia Plástica do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE). Resultados: Foram revisados e incluídos os prontuários de 18 pacientes, 15 (83,3%) do sexo feminino e 3 (16,7%) do masculino, com idade variando de 16 a 79 anos (média de 41 anos). Dezessete pacientes possuíam histórico de cirurgia prévia (94,4%), sendo a cesárea presente em 8 dos casos (44,4%), seguida de cirurgia oncológica com 6 (33,3%), cirurgia do trauma com 2 (11,1%) e bariátrica com 2 (11,1%). Em relação à etiologia do defeito, 8 (44,4%) eram decorrentes de fasciite necrosante, 4 (22,2%) de hérnia incisional, 2 (11,1%) por trauma, 2 (11,1%) por infecção de ferida operatória e 2 (11,1%) por neoplasia de parede abdominal, sendo somente um (5,5%) paciente com defeito de espessura total. A técnica cirúrgica de separação dos componentes foi realizada em 7 dos casos (38,9%), seguida de retalho de avanço simples em 6 (33,3%), fechamento com tela associado à abdominoplastia em 3 (16,7%), e expansor tecidual em 2 (11,1%). Quanto às complicações, houve 4 casos (22,2%). Conclusões: Defeitos de parede abdominal são casos desafiadores para o cirurgião plástico, seu tratamento se mostra árduo, porém com resultados satisfatórios mesmo nos casos mais severos.

Introduction: Patients with abdominal wall defects present challenging complications that require the use of advanced surgical approaches. Methods: This primary, retrospective, and descriptive study evaluated patients who underwent abdominal wall reconstruction at the Plastic Surgery Service of the Clinics Hospital of the Federal University of Pernambuco. Results: The medical records of 18 patients were reviewed, including 15 women (83.3%) and 3 men (16.7%), with a mean age of 41 years (range, 16-79 years). Seventeen patients (94.4%) had a history of previous surgery. The causes of abdominal injury were cesarean section in eight cases (44.4%), oncologic surgery in six (33.3%), trauma surgery in two (11.1%), and bariatric surgery in two (11.1%). The etiology of the defect was necrotizing fasciitis in eight cases (44.4%), incisional hernia in four (22.2%), trauma in two (11.1%), surgical wound dehiscence in two (11.1%), abdominal wall neoplasia in two (11.1%), and total thickness defect in one (5.5%). The surgical interventions included the component separation technique in seven cases (38.9%), simple VY advancement flap in six (33.3%), closure with abdominoplasty in three (16.7%), and tissue expander in two (11.1%). Four patients (22.2%) presented complications. Conclusions: Abdominal wall defects are challenging cases for plastic surgeons, as their treatment is difficult, but the results are satisfactory even in the most severe cases.

Necrotizing fasciitis: eight-year experience and literature review

OBJECTIVES: To describe clinical, laboratory, microbiological features, and outcomes of necrotizing fasciitis. METHODS: From January 1, 2004 to December 31, 2011, 115 patients (79 males, 36 females) diagnosed with necrotizing fasciitis were admitted to Mackay Memorial Hospital in Taitung. Demographic data, clinical features, location of infection, type of comorbidities, microbiology and laboratory results, and outcomes of patients were retrospectively analyzed. RESULTS: Among 115 cases, 91 survived (79.1%) and 24 died (20.9%). There were 67 males (73.6%) and 24 females (26.4%) with a median age of 54 years (inter-quartile ranges, 44.0-68.0 years) in the survival group; and 12 males (50%) and 12 females (50%) with a median age of 61 years (inter-quartile ranges, 55.5-71.5 years) in the non-surviving group. The most common symptoms were local swelling/erythema, fever, pain/tenderness in 92 (80%), 87 (76%) and 84 (73%) patients, respectively. The most common comorbidies were liver cirrhosis in 54 patients (47%) and diabetes mellitus in 45 patients (39%). A single organism was identified in 70 patients (61%), multiple pathogens were isolated in 20 patients (17%), and no microorganism was identified in 30 patients (26%). The significant risk factors were gender, hospital length of stay, and albumin level. DISCUSSION: Necrotizing fasciitis, although not common, can cause notable rates of morbidity and mortality. It is important to have a high index of suspicion and increase awareness in view of the paucity of specific cutaneous findings early in the course of the disease. Prompt diagnosis and early operative debridement with adequate antibiotics are vital. .

Fascitis necrotizante: reporte de dos casos / Necrotizing fascitis: a two case report

Se presentan dos casos clínicos, egresados vivos, con el diagnóstico de fascitis necrotizante de 12 y 13 meses de edad. La morbilidad pediátrica por esta enfermedad es baja, pero tiene una alta mortalidad. Su pronóstico es sombrío y sólo el tratamiento de forma multidisciplinaria en terapia intensiva, diagnóstico precoz, cirugía agresiva y antibioticoterapia polimicrobiana permite lograr mejores resultados. Se comenta el valor de la terapia oxigenante como tratamiento coadyuvante en el tratamiento de esta enfermedad

Fascitis necrotizante / Necrotizing fascitis

Determinar la frecuencia de infección por fascitis necrotizante. Revisión retrospectiva de las historias médicas en los últimos cinco años 1995-2000. Servicio de Cirugía del Hospital Central "Dr. Daniel Plácido Rivero" San Felipe, Estado Yaracuy. Se identificaron 26 pacientes de los cuales 21 (80 por ciento) masculinos y 5 (20 por ciento) femeninos, la edad media de las pacientes fue de 29 años. El promedio de hospitalización fue de 7 a 14 días. El tiempo transcurrido hasta el establecimiento del diagnóstico fue inmediato para los sobrevivientes y de 3 días para los fallecidos. Los resultados de nuestra revisión demuestran 24 (93 por ciento) con resultados satisfactorios y pacientes (7 por ciento) fallecidos. Se demostró que los retrasos en el diagnóstico y el tratamiento quirúrgico son los factores más importantes que contribuyeron a la mortalidad debida a la fascitis necrotizante