Necrotizing Fasciitis of the Upper Extremity

The patient was a 66 year-old male who was admitted to our hospital with extensive cellulitis and fasciitis of his left chest wall and axillary region. He mentioned trauma to his left arm 2 months ago which had caused a swelling and tenderness in his left arm. In another hospital he had undergone several debridements of soft tissue necrosis and broad spectrum antibiotic therapy. The patient had been diagnosed having necrotizing fasciitis at the previous hospital and the “finger probe test” was positive which identifies the disease.

He had a history of uncontrolled diabetes mellitus and coronary artery disease (Figure 1, 2, 3)

Sensitive image. Click to unblur

The patient was transferred to the ICU and after evaluating the wound the decision to amputate the extremity was made and amputation was done the day after admission. In order to control his infection after taking multiple cultures from his wound, blood and urine, high-dose clindamycin, vancomycin and 24 million units of crystal penicillin was started.

Sensitive image. Click to unblur

During the first postoperative day the patient developed a low hemoglobin and a 2.5 mg/dl creatinine, thus the antibiotic regimen was adjusted accordingly. The patient also had a post operative blood sugar of 331 mg/dl.

Sensitive image. Click to unblur

The patient became lethargic and because of his respiratory distress he was intubated and mechanical ventilation was started. 

On the second postoperative day the patient’s metabolic acidosis progressed and because of increasing creatinine levels acute tubular necrosis was diagnosed. He received 2 units of packed cell and Lasix. On the 3rd postoperative day he developed a low blood pressure which was unresponsive to dopamine drip. On the same day the patient had bradycardia and asystole and underwent CPR. The CPR was unsuccessful and the patient passed away.

Corresponding author: Mohammad Hosein Kalantar Motamedi, Trauma Research Center, Baqiyatallah University of Medical Sciences