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Official Journal of the Italian College of Phlebology
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Acta Phlebologica 2001 December;2(2-4):77-9

language: English

Necrotizing fasciitis. Case report

Baggio E. 1, Simoncini F. 1, Migliara B. 1, Riva F. 1, Landoni L. 1, Boninsegna L. 1, Veroux P. F. 2, Lipari G. 1

1 Department of Surgery and Gastroenterology, Chair of General Surgery, University of Verona;
2 Department of Surgical Sciences, Transplant and Advanced Technologies, University of Catania


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Necrotizing fasciitis is a severe and rapidly progressive infection of the deep and subcutaneous tissue mainly complicating surgical procedures. The disease, due to a polymicrobial infection, is uncommon and associated with a high mortality rate. We present a case of necrotizing fasciitis complicating long saphenous vein surgery. A smoker, 61 year old woman, underwent stripping of the long saphenous vein and multiple phlebectomy by the Muller method. Three days after surgery the patient suffered from aching inguinal pain with fever. Biochemical tests revealed renal failure and electrolytic disorders. A surgical drainage of the inguinal wound was performed. During the following days, despite antibiotic therapy and cardiovascular support the clinical conditions worsened until septic shock with respiratory distress syndrome and spread of the infection involving all the abdominal and thoracic wall till the axillary area. According to CT evidence of an abscess, we performed multiple incisions from the axillary region as far as the inferior limb with positioning of large drainage tubes for continuous washing of the collection. Parenteral antibiotic therapy was modified several times according to antibiogram. In the following days, the improving clinical conditions, led to recovery in one week. An extensive surgical debridement of all necrotic tissue with multiple fascectomy and appropriate antimicrobial treatment are the cornerstones of a successful outcome. Cardiovascular support is essential to avoid the evolution to septic shock. Necrotizing fasciitis is a rapidly progressive disease and a potentially lethal condition associated with a high mortality, on average 30%, despite surgical treatment. In our experience a combination of aggressive surgery, wide antimicrobial treatment, and strong support therapy can otherwise lead to recovery

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