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#1
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07-11-2014, 09:13 PM
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 ✖ The Antique Christ ✖ Poster Rank:105 Gonzo Punk Join Date: Jan 2009 Posts: 15,488
Contributions: 58
Mentioned: 23 Post(s) Quoted: 2046 Post(s)
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Necrotizing Fasciitis After a Fall
A 65-year-old smoker with no known medical history presented to a Veterans Affairs emergency department with pain for 4 days after a fall forward onto his shoulder at home. On physical examination, the patient was afebrile and tachycardic to 110 beats/min. His right shoulder was warm and foul smelling and had a large area of black necrotic tissue and subcutaneous bullae, with surrounding swelling and erythema (Figure 1). Crepitus was palpable superiorly and anteriorly. Radiograph of the shoulder revealed no dislocation, a prominent air-fluid level, and subcutaneous emphysema (Figure 2).  View of the right shoulder.  Radiograph of the right shoulder. Diagnosis Necrotizing fasciitis Necrotizing fasciitis is an uncommon, rapidly progressive infection involving the fascia and subcutaneous tissue. In type 1, isolates are polymicrobial and synergistic. Our patient's original blood culture grew oxacillin-resistant Staphylococcus xylosus. Wound culture from postoperative day 1 grew Streptococcus anginosus/milleri. Type 2 involves Streptococcus pyogenes alone or in combination with Staphylococcus aureus. Exotoxins secreted by pathogens in each type enhance their virulence and accelerate the progression of infection. Predictors of mortality include age, depth of the primary site of infection, and associated comorbidities, such as diabetes mellitus, peripheral vascular disease, alcoholism with chronic liver disease, and cancer with immunosuppression. However, the most significant predictor of mortality is time to surgical intervention. Our patient was taken urgently to the operating room for debridement and returned 3 times for additional debridements and eventually a skin graft. Five-month follow-up showed excellent recovery and take of skin grafts, although there was a lack of abduction past 70% because of the extensive deltoid debridement. |
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#2
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07-11-2014, 09:34 PM
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 ★ Legacy Member ★ Poster Rank:193 All woman Join Date: Jun 2012 Posts: 7,774 Mentioned: 22 Post(s) Quoted: 1420 Post(s)
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Re: Necrotizing Fasciitis After a Fall
Wow, you mean someone actually got treatment at the VA????
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#4
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07-13-2014, 05:13 AM
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 My Rank: FIRST SERGEANT Poster Rank:405 Male Join Date: Nov 2009 Posts: 2,966 Mentioned: 18 Post(s) Quoted: 448 Post(s)
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Re: Necrotizing Fasciitis After a Fall
That's terrible.. simply fall on your shoulder and end up with Necrotizing fasciitis... That'll be how I'll end up with it.. trip and bump my hip or something.. have to get like 50% of my body removed.  I'm a glutton for punishment.. and though I hope I never see this on myself?...  |
