综合治疗急性坏死性筋膜炎25例

Comprehensive treatment of 25 cases of acute necrotizing fasciitis

2013年5月—2020年3月,北京朝阳急诊抢救中心收治25例急性坏死性筋膜炎患者,其中男18例、女7例,年龄7~78岁,病变部位主要位于下肢,原始病变范围20 cm×15 cm~83 cm×42 cm。入院后行全身综合治疗,尽早将病灶区域切开引流,去除坏死组织。待创面坏死组织有所减少时开始行负压封闭引流,创面好转后予以直接缝合或取头部和/或大腿刃厚皮或局部皮瓣转移修复。术后皮片及皮瓣均存活良好,创面完全封闭。25例患者均未截肢。21例患者随访半年以上,急性坏死性筋膜炎未复发,创面愈合后患肢功能较发病前无差别。

From May 2013 to March 2020,25 patients with acute necrotizing fasciitis were admitted to Beijing Chaoyang Emergency Rescue Center,including 18 males and 7 females,aged 7 to 78 years.The lesions were mainly located in the lower extremities,with the original lesion areas ranging from 20 cm×15 cm to 83 cm×42 cm.After admission,comprehensive systemic treatment was performed,the lesion area was cut open and drained as soon as possible,and the necrotic tissue was removed.Vacuum sealing drainage was performed when the necrotic tissue in the wound was reduced.The wounds were directly sutured or repaired with thin split-thickness skin grafts taken from head and/or thigh or local skin flaps after the wounds were improved.The skin grafts and flaps survived well after surgery,and the wound was completely closed.None of the 25 patients had amputation.A total of 21 patients were followed up for more than half a year,showing no recurrence of acute necrotizing fasciitis and no difference in the function of their injured limb after the wound healing than before the onset.