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Khirurgii

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Year 2020 Vol. 28 No 3

CASE REPORTS

V.A. BELOBORODOV, A.P. FROLOV

EMPHYSEMATOUS OSTEOMYELITIS COMPLICATED BY NECROTISING FASCIITIS AND MYOSITIS

Irkutsk State Medical University, Irkutsk,
The Russian Federation

Emphysematous osteomyelitis is an extremely rare, potentially fatal bacterial disease characterized by the presence of gas within bone and adjacent soft tissues.
The disease is often complicated by anaerobic necrotizing fasciitis. The article presents a clinical observation of successfully treated emphysematous osteomyelitis of the right femur complicated by necrotizing fasciitis and myositis in the 55-year-old man. The disease manifested 20 years later after a closed fracture of the right femur and osteosynthesis. Emphysematous osteomyelitis was characterized by severe pain in the right thigh, serious intoxication syndrome and the presence of gas bubbles in the medullary cavity of the right femur which was observed in the computed tomography scans.
The feature of emphysematous osteomyelitis management was a three-step approach. The first step was the opening of the purulent-necrotic focus with a wide longitudinal incision of the skin and fascia, excision of necrotic soft tissues. The second step was guillotine amputation of the right lower limb on the level of the upper third of the thigh. The third step was the formation of the thigh stump in the early stages with flow-washing drainage of a wound. This tactic helped to reduce the risk of primary amputation, saved more soft tissue to form the thigh stump more suitable for prosthetics and to shorten the treatment terms.

Keywords: emphysematous osteomyelitis, intraosseous gas, necrotizing fasciitis, necrotizing myositis
p. 344-349 of the original issue
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Address for correspondence:
664003, Russian Federation
Irkutsk, Krasnoe Vosstaniye str., 1,
Irkutsk State Medical University,
the Department of General Surgery
and Anesthesiology,
tel. mobile: +7 914 884-50-96,
e-mail: frolovphd@mail.ru,
Frolov Aleksandr P.
Information about the authors:
Beloborodov Vladimir A., MD, Professor, Head of the Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-3299-1924
Frolov Aleksandr P., PhD, Associate Professor of the Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-3453-548X
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