Clinical case of complex treatment anaerobic non-clostridial necrotizing cellulofasitis by using modern bioplastic material

Necrotizing cellulitis is an infection most often caused by mixed aerobic and anaerobic microflora or Clostridium perfringens, which affects the superficial and deep fascia and subcutaneous fat. Necrotic pyogenic infection (NPI) usually occurs as a result of infection of tissues with Streptococcae group A (for example, Streptococcus pyogenes) or by the association of aerobic and anaerobic bacteria (for example, Bacteroides species). Streptococci can reach the site of inflammation from distant foci of infection by hematogenous. This infectious disease most often affects the limbs and the perineum. NPI causes tissue ischemia as a result of extensive occlusion of small vessels in the subcutaneous fat. Vascular occlusion leads to heart attack and tissue necrosis, which increases the number of obligate anaerobes (for example, Bacteroides) and stimulates the anaerobic metabolism of facultative pathogens (for example, Escherichia coli). The chain of the listed pathophysiological reactions is the cause of the development of gangrene in patients with NPI.

The main method of treating NPI is surgical. Indications for surgical treatment are blistering, ecchymosis and fluctuations symptom. The initial incision should be extended until it becomes possible to separate the skin with subcutaneous fat from the fascia with a tool or finger. The most common mistake is non-radical surgical treatment. Repeated surgical treatments with removal of necrosis to the boundaries of healthy tissues should be repeated every 1–2 days – this procedure should become routine. Additionally prescribed intravenous infusions of antibiotics, usually include 2 or more drugs. The choice of antibiotic therapy should be based on the results of bacteriological research. Intensive detoxification requires the introduction of large volumes of fluid before and after surgery. After surgical treatment, extensive wound defects of soft tissues are formed, requiring elimination by reconstructive and plastic surgeries.

The article presents a clinical example of successful patient with a severe NPI treatment. Surgical treatment of the underlying disease and the replacement of an extensive wound defect using bioplastic material were performed.

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