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A case report of necrotizing soft tissue infection of the chest wall : Effective management with serial debridement

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Title: A case report of necrotizing soft tissue infection of the chest wall : Effective management with serial debridement
Authors: Fujii, Masakazu Browse this author
Imamura, Kiyotaka Browse this author
Kato, Kentaro Browse this author
Takada, Minoru Browse this author
Ambo, Yoshiyasu Browse this author
Nakamura, Fumitaka Browse this author
Hirano, Satoshi Browse this author →KAKEN DB
Keywords: Necrotizing soft tissue infection
Chest wall
Serial debridement
Group A streptococcus
Issue Date: May-2021
Publisher: Elsevier
Journal Title: International journal of surgery case reports
Volume: 82
Start Page: 105908
Publisher DOI: 10.1016/j.ijscr.2021.105908
Abstract: Introduction: Necrotizing soft tissue infection (NSTI) of the chest wall is a rare, rapidly spreading, highly lethal surgical disease. Radical debridement interferes with the important anatomical function of the chest wall. We re-port a case of chest wall NSTI that was successfully managed with early diagnosis and serial debridement. Presentation of case: A 43-year-old, previously healthy woman presented with severe malaise and worsening right axillary pain. She was severely lethargic and had a painful, large, pale lesion with surrounding erythema of the right chest and trunk. Computed tomography revealed NSTI, with diffuse soft tissue inflammation extending from the axilla to the lower abdomen. There was no obvious entry portal. Prompt surgical drainage was established. Group A streptococcus infection was diagnosed. During her 3-month postoperative course, she underwent four more surgeries, including two debridements. This treatment proved successful and avoided the need for complicated muscle flap reconstruction. She was discharged on postoperative day 109. Discussion: Group A streptococcus can cause NSTI even in immunocompetent patients without an entry portal. Radical debridement is recommended for infection control. Preserving anatomical chest wall function, however, is also important. Serial debridement with close follow-up solved the problem in this patient. Conclusions: Serial debridement with close follow-up enabled to avoid large tissue deficits and complicated re-construction in the case of NSTI of the chest wall. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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