A 77-year-old woman presented with a history of hypertension and asthma, no allergies and no toxic habits.
She came to the emergency room for an episode of dizziness and profuse sweating.
The patient suffered an accidental fall (114 beats per minute) and suffered a fall 4 days earlier, with trauma to the limbs which did not cause skin lesions or entry doors at that time.
At 48 hours edema and blisters appeared in both pathologies causing pain to the patient.
Urgent laboratory tests were performed, showing hemoglobin 9 ́5 mg/dl, leukocytosis 21890 x 10^9/l with 90% neutrophils, creatinine 2 ́3 mg/dl (previous 1 ́1 mg/dl) and CPK
After performing these tests, they warn the plastic surgeon of the daycare center to assess the lesions present in the lower limbs: edema and swelling, with crepitation, presence of blisters and severe local areas of epidermolysis.
Due to the patient's general condition, the hemorrhagic aspect of the lesions and pain disproportionate to the exploration, the diagnosis of suspicion was bilateral necrotizing fasciitis with no local wound healing factor alone that the patient did not present general factors.
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It was decided to perform an urgent surgical intervention, performing wide debridement of both lower limbs to the muscular plane, which shows signs of vitality.
At 24 hours the patient is stable, with no signs of infection progression in the lower limbs.
However, at 48 hours the infection in the left lower limb has progressed, new surgical intervention is performed in which debridement of the affected tissues is performed.
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On the sixth day after admission, we received the result of the pathological study of the debrided tissue that provided the definitive diagnosis of necrotizing fasciitis, presenting important phenomena of ischemia and necrosis of the subcutaneous and hemorrhagic fascia, with vessels
The local evolution was favorable, but his general condition remained serious.
Fifteen days after admission the patient developed an acute abdomen requiring urgent surgical intervention with Hartmann necrosis plate in the sigmoid colon and an intraparietal abscess with fecaloid content. Resection was performed.
The patient's general condition did not improve and there was local worsening of the left lower limb, so it was decided to perform a new urgent surgical intervention 20 days after admission, performing left lower limb amputation.
After this surgery the patient begins to improve, not requiring new interventions for debridement, but to achieve coverage of the debridement areas.
The initial antibiotic treatment consisted of piperacillin-ta with high doses of medication and was subsequently changed to vancomycin + imipenem for a more adequate coverage of the associated acute abdomen.
Microbiological tissue cultures performed in the first intervention revealed Clostridium species as the only germ present.
Two months after admission to our service the patient was discharged.
It is followed every six months in outpatient plastic surgery and rehabilitation.
Its general condition is good and depends on basic activities of daily living, with no local complications.
