Treatment of Complex and Severe Pressure Sore with Perineal Necrotizing Fasciitis by Flushing Negative Pressure: A Report of 12 Cases

Special Article – Surgery Case Reports

Austin J Surg. 2019; 6(18): 1208.

Treatment of Complex and Severe Pressure Sore with Perineal Necrotizing Fasciitis by Flushing Negative Pressure: A Report of 12 Cases

Zheng X, Lu W, Wang CM, Tian GJ and Zheng YK*

Department of Diagnosis and Treatment of Chronic wounds, Affiliated Hangzhou First People’s Hospital, University School of Medicine, China

*Corresponding author: Yong-ke Zheng, Department of Diagnosis and Treatment of Chronic wounds, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou Geriatric Hospital, Hangzhou, 310022, Zhejiang, China

Received: July 03, 2019; Accepted: August 21, 2019; Published: August 28, 2019

Abstract

Objective: To investigate the efficacy of flushing negative pressure in the treatment of complex and severe pressure ulcers complicated with perineal necrotizing fasciitis.

Methods: A total of 12 patients with complex and severe pressure ulcers complicated with perineal necrotizing fasciitis were given comprehensive treatment such as anti-infection and anti-shock. After the condition was relatively stable, the wounds were treated with washing negative pressure and other minimally invasive treatment. Results: Among the 12 patients, 1 died of multiple organ failure due to sepsis, and the rest were cured successfully with wound healing.

Conclusion: The clinical incidence and cure rate of complex and severe pressure sore complicated with perineal necrotizing synovitis are low. Such patients progress rapidly and have poor prognosis. The method of flushing negative pressure can reduce iatrogenic trauma, alleviate the pain of patients and improve the cure rate. This method is simple and easy to operate, and has high academic value and clinical significance.

Keywords: Flushing negative pressure; Severe pressure sores; Necrotizing fasciitis

Introduction

Pressure ulcer is a common complication of elderly patients. In recent years, with the increase of paraplegia after trauma caused by traffic accidents, the pressure ulcer in the young is also increasing year by year. The clinical incidence of necrotizing fasciitis is low, and pressure sore complicated with perineal necrotizing fasciitis is even rare. There is a lack of mature and effective treatment in clinic. Once the patient has pressure sores, usually cannot find a suitable medical institution, most of them “change their dressing” at home. Due to the limitations in environment and technique, the wound infection is almost inevitable. Pressure ulcers complicated with necrotizing perineal fasciitis will make the patients in very complicated and dangerous situation. Any invasive treatment with great irritation is not applicable to such patients. Twelve patients with complex and severe pressure ulcers complicated with perineal necrotizing fasciitis were mainly treated with flushing negative pressure. The results show that this method can reduce iatrogenic trauma, alleviate the pain of patients and effectively improve the cure rate.

Basic Information

From March 2014 to March 2019, 12 cases of complicated and severe pressure ulcers with necrotizing perineal fasciitis were admitted and treated in our hospital. This group includes 8 males and 4 females (33.3%), the age ranges from 41 to 72 with the average of 54. The history of pressure ulcer ranges from 34 days to 14 years. Among them, 11 patients had stage 4 pressure sores at the ischial tuberosity (91.7%), 1 patient had stage 4 pressure sores at the left hip, and 5 patients (41.7%) had multiple pressure sores (Bilateral ischial nodular sinus pressure sore and sacral stage 4 pressure sore). Of the 11 patients with stage 4 pressure sores at the ischial nodules combined with perineal necrotizing fasciitis, 8 patients had paraplegia caused by trauma, accounting for 72.7% (8/11), and 3 patients were paralyzed by spinal cord neuritis. Three patients were complicated with diabetes. Except for 3 cases without obvious shock symptoms, the other 9 patients developed septic shock in varying degrees (75.0%). There were 4 patients with positive peripheral blood bacterial culture, accounting for 33.3% (4/12) and 44.4% (4/9) of septic shock patients. Among them, 1 case was Gram-positive cocci (Staphylococcus aureus), accounting for 25% (1/4), and the other 3 cases were Gram-negative bacteria (2 cases of Escherichia coli and 1 case of Pseudomonas aeruginosa). The culture results of bedsore secretions are shown in Table 1.