| Summary: | Introduction. Necrotizing fasciitis is a rare, progressive bacterial
infection of superficial fascia followed by secondary subcutaneous tissue
necrosis. We pressented a patient with massive fulminant lifethreatening
necrotising fasciitis after bellow-knee femoro-popliteal vein bypass grafting
successfully treated by antibiotics, surgical debridement and final skin
reconstruction using the Tierch method. Case report. A 61-year-old patient
was ad-mitted to the Vascular Surgery Clinic for below-knee femoro-popliteal
bypass grafting. He complained of intermittent claudication in the left leg
after 50 m, ankle brachial indexes were 0.45 on the left and 1.0 on the right
side. Femoropopliteal below-knee bypass grafting was done using the
autologous great saphenous vein. In the very next day, initial signs of skin
infection appeared including local inflammation, erythema, swelling and
cellulitis restricted to saphenectomy site. These changes had rapidly spread
in the following days on the deep tissue of the whole upper and lower leg,
including the groin and with clinical signs of life-threatening systemic
infection. Immediate surgical debridement was done followed by extensive
wound packing and wide spectrum antibiotics administration for the next 33
days when final skin reconstruction by the Tierch method was performed.
Interesting point is that this entire time wound swab was sterile.
Conclusion. In the presented case immediate surgical debridement, wide
spectrum antibiotics administration and consistent wound packing gave
satisfactory results in this life-threatening systemic infection. Wound swab
is not always a reliable indicator of the infection while clinical findings
and surgeons’ experience are of great significance in rapid reaction to this
rare surgical complication. [Projekat Ministarstva nauke Republike Srbije,
br. 41002]
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