A 44-year-old woman with a medical history of chronic renal failure on hemodialysis since 2005.
In April 2010, she underwent a kidney transplant from a cadaveric donor, prior treatment.
On the fourth postoperative day the patient developed fever, worsening of the general condition and erythematous lesions in the right flank, which rapidly progressed to the appearance of blisters and skin necrosis.
The Nephrology service performs biopsy and culture of the lesions and requests collaboration of our Service.
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due to the clinical suspicion of necrotizing fasciitis, it was decided to start intravenous antibiotic therapy (IV) and perform immediate surgical debridement to the muscular plane, without including it, covering an area of approximately 25 x 25 cm in flac.
Treatment was adjusted by maintaining radiation therapy (Tacrolimus alone) and stopping Mycophenolate and Dacortin with broad-spectrum intravenous antibiotic therapy with ciprofloxacin (400 mg every 12 hours), Tecortin.
Samples obtained for culture were positive for Escherichia Coli.
After debridement, treatment was started with negative pressure therapy with VAC® system for 13 days at 125 mmHg and healing every 48 hours.
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Once cleaned, granulated and free of infection the problem area (13 days after debridement), we proceeded to coverage by autologous grafts of partial thickness skin again associated with VACofam therapy performed 48 days Grand dressing.
In the first post-transplantation phase, we found that the graft was adequately delivered and without acute complications such as infection or type, a fact that led to the removal of the antibiotic treatment and the re-initiation of the treatment Nephrology.
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Twenty-four days after admission, the patient was discharged from the hospital by the Department and remained under outpatient cure or prophylaxis with tugraso antibiotics and impregnated povidone gauze and gauze.
The first appointment in the plastic surgery outpatient clinic was made two weeks after hospital discharge (18 days post-injection), when we found the cured problem area.
At 6 months, follow-up was performed.
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The therapeutic association of IV antibiotics, the suppression of 2 of the partial tensions in the autologous wound that the patient took for his renal transplant, the surgical debridement and the VAC® therapy, allowed to accelerate the skin cleansing process.
It was offered the possibility of implanting two cutaneous expanders and practicing a more aesthetic posterior reconstruction, but the patient declined the offer to feel satisfied with the current result.
