Clinical findings | First case: 69 yr/M DM-type II, with NF of CW, shoulder, and arm | Secound case: 63 yr/M DM-type I, paraplegic with Fournier's gangrene | Third case: 56 yr/M with inquinal hernia repair and NF of AW and RP space |
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Preexisting medical conditions | DM type-II, hypertension, alcohol abuse, heart disease, peripheral vascular and pulmonary disease, malnutrition, chronic wound (pressure sores, diabetes and venous ulcer) | DM type I, hypertension, paraplegia, obesity, heart disease, peripheral. vascular and pulmonary disease, immune deficiency, pressure sores | hypertension, alcohol abuse, peripheral vascular disease |
Physical findings | swelling, erythema, redness, induration, crepitus, pain, fever, warm skin, blisters, skin discoloration, numbness, soft tissue emphysema, confusion, weakness, skin sloughing/necrosis | induration, pain, crepitus, fever, warm skin, blisters, skin discoloration, soft tissue emphysema, paraplegia confusion, numbness | swelling, erythema, redness, induration, crepitus, pain, fever, warm skin, blisters, soft tissue emphysema, confusion, weakness, skin sloughing/necrosis |
Vital sings and laboratory valves | SIRS and signs of systemic toxicity, positive LRINEC scour system. | SIRS and signs of systemic toxicity, positive LRINEC scour system. | SIRS and signs of systemic toxicity, positive LRINEC scour system |
Source of infection | skin abscess/furunculosis | perineal abscesses, Fournier's gangrene | inguinal hernia repair, bowel perforation. |
Microbiology findings | aerobes and anaerobes | aerobes and anaerobes | aerobes and anaerobes |
Treatment modalities: | |||
primary debridement | yes | yes | yes |
operative intervals (days): | |||
admission to first debridment | 3 hours | 6 hours | 72 hours |
first to last debridment | 2 | 5 | 5 |
first debridement. to final closure | 14 days | 12 days | 12 days |
days to granulation tissue formation | 7 days | 10 days | 10 days |
hydrofiber dressing | yes | yes | yes |
Adjuvant HBO therapy | yes | yes | yes |
HBO sessions | 4 sessions | 11 sessions | 11 sessions |
Combination of antibiotics used | Penincillin G, Clindamycin, Imipenem, Teicoplanin | Penicilin G, Gentamycin, Clyndamicin | Penicilin G, Gentamycin, Clyndamicin, Metronidazol |
Outpatient treatment | oral anti-diabetic drugs, antihypertensive drugs, cardiotonics | Insulin therapy, antihypertensive drugs, cardiotonics, different types of peroral antibiotics for 2 months | antihypertensive drugs, cardiotonics, |
ICU therapy | dominantly mechanical ventilation, nutritional support, whole blood, fresh frozen plasma, erythrocyte concentrate, combination of 4 antibiotics (AB) which depending on wound culture or blood culture (administered for 10 days and target AB for 18 days) | dominantly dialysis, nutritional support, blood whole blood, fresh frozen plasma, erythrocyte concentrate combination of 3 antibiotics which depending on wound culture or blood culture (administered for 10 days and target AB for 11 days) | dominantly nutritional support whole blood, fresh frozen plasma, erythrocyte concentrate combination of 4 antibiotics which depending on wound culture or blood culture (administered for 14 days) |
Main complications | delay in diagnosis and first debridement, inadequate serial debridement's, bacteriemia, sepsis, wound infection (MRSA), pressure sores, skin graft lysis | delay in diagnosis and first debridement, inadequate serial debridement, bacteriemia, sepsis, MODS, wound infection-MRSA, skin graft lysis, diverting colostomy, pressure sores | delay in diagnosis and first debridement, inadequate serial debridement, bowel perforation, bacteriemia, sepsis, secondary peritonitis, MODS, wound infection(MRSA), diverting colostomy, pressure sores |
Reconstruction | skin grafts (SG), local flaps, topical negative pressure therapy with SG | skin grafts, local flaps, topical negative pressure therapy with SG, component separation technique with biological mesh | direct sutures, local flaps, component separation technique with biological mesh |