Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2018 Vol. 26 No 1

CASE REPORTS

DOI: https://dx.doi.org/10.18484/2305-0047.2018.1.109   |  

K.V. LIPATOV 1, E.A. KOMAROVA 1,2, A.V. BORODIN 1,2, Y.V. STRUCHKOV 1, V.V. FROLKOV 2, A.V. KIRILLIN 1,2 , M.A. KIRYUPINA 1

NECROTIZING INFECTION OF SOFT TISSUES AS THE COMPLICATION OF PERFORATING TUMOR OF SIGMOID COLON

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 1,
City Clinical Hospital named after I.V. Davydovsky, Moscow 2,
The Russian Federation

This clinical case demonstrates the development of severe streptococcal (Streptococcus pyogenes) necrotizing soft tissue infection as a result of perforation of the sigmoid neoplasm. The rapidly progressive necrotic process in the soft tissues of the lumbar and gluteal region as well as necrotic process in the left thigh (with the predominant lesion of the superficial fascia, subcutaneous fat and skin) led to the formation of an extensive postnecrectomic wound defect with an area of more than 1000 square centimeters. In addition to the severity of illness, the patients belated treatment and the underestimation of the clinical situation by surgeons who provided emergency care contributed to such an extensive spread of the pathological process. The development of sepsis was accompanied by severe multiple organ failure. Because of the severity of the patients condition, the surgical removal of the sigmoid neoplasm extended in the abdomen wall became possible only after its stabilization as a result of surgical focal sanation and complex intensive therapy in the conditions of the ICU. The most important point of the stage-by-stage surgical treatment was the choice of methods for the plastic closure of an extensive postnecrectomic wound that involved the entire left gluteal region, part of the lumbar and antero-inner surface of the left thigh. Taking into account the size and localization of the defect, the plastic reserves of the surrounding skin, the wound was closed in three stages with the help of combined plastic surgery techniques: with local tissues by the method of tissue expansion and a split-thickness skin graft.

Keywords: soft tissue infections, necrotizing fasciitis, streptococcus pyogenes, plastic surgery, skin transplantation
p. 109-114 of the original issue
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Address for correspondence:
119991,The Russian Federation,
Moscow, Bolshaya Pirogovskaya str., 2-4,
I.M. Sechenov First Moscow State Medical University (Sechenov University),
Department of General Surgery,
Tel. mobile: +7 (916) 635-89-88,
e-mail: k_lipatov@mail.ru,
Lipatov Konstantin V.
Information about the authors:
Lipatov Konstantin V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-9902-2650
Komarova Elena A., PhD, Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University); Surgeon of the Purulent Surgery Unit, City Clinical Hospital named after I.V. Davydovsky, Moscow, Russian Federation.
http://orcid.org/0000-0003-0900-3577
Borodin Alexey V., PhD, Acting Head of the Purulent Surgery Unit, City Clinical Hospital named after I.V. Davydovsky; Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-9583-2023
Struchkov Yuri V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-7340-7878
Frolkov Valery V., PhD, Head of the Anaesthesiology, Reanimation and Intensive Care Unit, City Clinical Hospital named after I.V. Davydovsky, Moscow, Russian Federation.
http://orcid.org/0000-0001-7813-199X
Kirillin Alexey V., PhD, Deputy Chief Physician on Surgery, City Clinical Hospital named after I.V. Davydovsky; Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. http://orcid.org/0000-0003-0585-9941
Kiryupina Maria A., Student of the 4th course of General Medicine Faculty, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0001-8133-8115
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