DOI: http://dx.doi.org/10.18203/2349-2902.isj20202869

The cadaveric human skin allograft as a paradigm shift for the management of a large wound of necrotizing soft tissue infection: an interesting case report

Madhusoodan Gupta, Deepti Varshney, Vimalendu Brajesh, Aditya Aggarwal, Vishal K. Biswkarma

Abstract


Necrotizing soft tissue infection (NSTI) is an uncommon but fatal and rapidly progressing disease which requires emergent recognition and prompt treatment. Patients of NSTI frequently suffer from large soft tissue defects, which require coverage of these defects by auto-skin graft or flap cover. It becomes a challenge to cover the soft tissue defects in an already sick patient. The patient of NSTI has a restricted skin graft donor site and a poor skin grafting bed. Here authors report a case of 50 years old female, known case of type 2 diabetes mellitus, who suffered from NSTI post intramuscular injection of the left gluteal region. Her left thigh, left gluteal region, lower back, pubic and perineal region were involved. She underwent multiple radical debridement’s followed by the use of Cadaveric human skin allografts to cover the raw area temporarily. Meanwhile, authors optimized the patient nutrition state and controlled the infections. Finally, raw areas were covered with an autologous skin graft, and the patient discharged in stable condition.


Keywords


Allograft, Auto-skin graft, Biological dressing, Cadaveric human skin allograft, Necrotizing soft tissue infection

Full Text:

PDF

References


Bonne SL, Kadri SS. Evaluation and management of necrotizing soft tissue infections. Infect Dis Clin North Am. 2017;31:497-511.

Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85:1454-60.

Davies HD, McGeer A, Schwartz B, Green K, Cann D, Simor AE, et al. Invasive group A streptococcal infections in Ontario, Canada. Ontario Group A Streptococcal Study Group. N Engl J Med. 1996;335:547-54.

Young MH, Engleberg NC, Mulla ZD, Aronoff DM. Therapies for necrotising fasciitis. Expert Opin Biol Ther. 2006;6:155-65.

Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg. 1996;224:672-83.

Angoules AG, Kontakis G, Drakoulakis E, Vrentzos G, Granick MS, Giannoudis PV. Necrotising fasciitis of upper and lower limb: a systematic review. Injury. 2007;38(Suppl 5):S19-26.

Heitmann C, Pelzer M, Bickert B, Menke H, Germann G. Surgical concepts and results in necrotizing fasciitis. Chirurg. 2001;72:168-73.

Giuliano A, Lewis F, Hadley K, Blaisdell FW. Bacteriology of necrotizing fasciitis. Am J Surg. 1977;134:52-7.

McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221:558-63.

Elliott D, Kufera JA, Myers RA. The microbiology of necrotizing soft tissue infections. Am J Surg. 2000;179:361-6.

Stevens DL. The flesh-eating bacterium: what’s next? J Infect Dis. 1999;179(Suppl 2):S366-74.

Majeski JA, John JF. Necrotizing soft tissue infections: a guide to early diagnosis and initial therapy. South Med J. 2003;96:900-5.

Oliver AM, Kaawach W, Mithoff EW, Watt A, Abramovich DR, Rayner CR. The differentiation and proliferation of newly formed epidermis on wounds treated with cultured epithelial allografts. Br J Dermatol. 1991;125(2):147-54.