摘要
患者女,37岁,境外旅游期间出现左下肢皮肤湿疹样病变,伴破溃、感染性休克、多器官功能衰竭,经3次清创术后病原学确诊为溶血性链球菌感染。于2024年6月10日转入北京协和医院整形外科查体示:左下肢大面积皮肤软组织缺损(肌肉裸露伴部分腓肠肌浅层肌肉缺失),腘窝及跟腱区肌腱外露。经多学科团队(MDT)会诊后行阶梯式创面修复:①左下肢创面清创+负压封闭引流;②右侧腹股沟区全厚皮片获取;③左大腿创面拉网植皮;④富血小板血浆局部治疗。专科护士主导的MDT护理模式实施系统性评估(含心理状态筛查),通过护理问题优先级排序实施精准干预。住院75 d期间完成7次手术,感染控制良好无并发症,最终实现左下肢皮肤修复完成且愈合良好,健肢负重站立,辅助器具辅助行走。本例为严重软组织感染继发创面的多学科救治提供了临床范式。
A 37-year-old female patient developed eczematoid lesions on the skin of the left lower extremity during overseas travel,accompanied by ulceration,septic shock,and multiple organ failure.After 3 debridement surgeries,the etiology was confirmed as hemolytic streptococcus infection.She was transferred to the department of plastic surgery,Peking Union Medical College Hospital on June 10,2024.Physical examination showed extensive skin and soft tissue defect of the left lower extremity(with exposed muscles and partial loss of the superficial layer of the gastrocnemius muscle),as well as exposed tendons in the popliteal fossa and Achilles tendon area.After consultation by the multidisciplinary team(MDT),staged wound repair was performed:①Debridement of left lower extremity wound+vacuum sealing drainage;②Harvesting of full-thickness skin graft from the right inguinal area;③Mesh skin grafting for left thigh wound;④Local treatment with platelet-rich plasma.The MDT nursing model led by specialized nurses implemented systematic assessment(including psychological state screening)and precise intervention through prioritization of nursing problems.During 75 days of hospitalization,7 surgeries were completed with well-controlled infection and no complications.Finally,the skin repair of the left lower extremity was achieved with good healing,and the patient could stand with weight-bearing on the healthy limb and walk with assistive devices.This case provides a clinical paradigm for multidisciplinary treatment of wounds secondary to severe soft tissue infections.
作者
刘湘玫
何悦
李子榕
薄海欣
王智
LIU Xiangmei;HE Yue;LI Zirong;BO Haixin;WANG Zhi(International Medical Services,General Ward 1,Chinese Academy of Medical Sciences Peking Union Medical College Hospital(West Campus),Beijing 100032,China)
基金
中央高水平医院临床科研专项(2022-PUMCH-B-031)。
关键词
筋膜炎
坏死性
休克
皮肤移植
创伤和损伤
Fasciitis,necrotizing
Shock
Skin transplantation
Wounds and injuries
