Necrotizing Fasciitis of the Left Lower Limb Complicated with the Abscess of Retroperitoneal Space: Case Report Presentation and a Retrospective Study

Abstract

\n Background: Necrotizing fasciitis(NF) is a severe progressive infectious disease where a synergistic action of multiple bacteria results in suppurative necrosis of the skin and soft tissue. Despite being a relatively uncommon infection, its mortality is significantly high. In this case report ,we describe the clinical presentation, management and outcome of a patient with NF of the left lower limb complicated with the abscess of retroperitoneal space and ensuing septic shock and dysfunction of heart and liver. Finally, we analyzed six cases we have treated before including this one and a retrospective study was performed.Case presentation: A 69-year-old male patient, complaining about the pain of left lower limb and high fever due to uncertain reasons, featuring the tenderness of affected limb and left lower abdomen , was diagnosed with the NF complicated with the abscess of retroperitoneal space. The patient then develop septic shock and dysfunction of heart and liver. After repeated debridement of necrosis tissue, in combination with multiple antibiotics, laboratory test methods and the vacuum-assisted closure(VAC) therapy, the patient survived ,gradually improved and finally got a full recovery.Methods: A retrospective study was performed on six patients with NF of unilateral lower limb from March 2018 to October 2019. All patients were given systemic antibiotics and nutrition support. During the first stage, repeated surgical debridement with negative-pressure wound therapy(NPWT) was performed. Direct suture of the wound was performed in the second stage. Results: The incision healed well in all patients, and no infection or necrosis occurred in the wound. During the follow-up of 6.5 months (range, 5-9 months), no recurrence of infection or incision rupture occurred.Discussion: Although prompt diagnosis and adequate antibiotic therapy are basic for the treatment of patients with NF, early and repeated surgical intervention is vital for a favorable outcome. Thus, adjuvant treatment for NF such as negative pressure wound therapy (NPWT) using the VAC are very useful to accelerate wound healing.Conclusions: Prompt diagnosis, adequate antibiotic therapy and more crucially, early and repeated surgical debridement of the necrotic tissue combined with VAC therapy play a collaborative role in the successful treatment of NF.