Department of Traumatology and Orthopedic Surgery, University Hospital Hassan II, Fes, MoroccoMorocco
Department of Dermatology, University Hospital Hassan II, Fes, MoroccoMorocco
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Necrotizing fasciitis (NF) is a life-threatening soft tissue infection characterized by a rapidly spreading infection of the subcutaneous tissue and in particular the fascia. Early diagnosis and radical surgical debridement are required. Surgery is indicated if NF is clinically suspected and must not be delayed by diagnosis in order to reduce mortality. We report a case of NF following surgery of an acral melanoma.
Keywords: fever; hypotension; tachycardia
ORTHOPEDICs RESEARCH AND TRAUMATOLOGY ISSN 2473-0963 Open Journal PUBLISHERS El Marfi Abdelhafid, MD1*; Samia Mrabat, MD2; Kaoutar Laamari, MD2; Mohammed El Idrissi, PhD1; Abdelhalim El Ibrahimi, PhD1; Abdelmajid El Mrini, PhD1; Zakia Douhi, MD2; Sara Elloudi, PhD2; Hanane Baybay, PhD2; Mernissi F . Zahra, PhD2 1Department of Traumatology and Orthopedic Surgery, University Hospital Hassan II, Fes, Morocco 2Department of Dermatology, University Hospital Hassan II, Fes, Morocco *Corresponding author Abdelhafid El Marfi, MD Department of Traumatology and Orthopedic Surgery, University Hospital Hassan II, Fes, Morocco; T el. +212 678 33 98 79; Fax. 05 35 61 37 29; E-mail: hafid.elmarfi@gmail.com Article information Received: November 7th, 2019; Revised: December 21st, 2019; Accepted: January 18th, 2020; Published: January 28th, 2020 Cite this article El Marfi A, Mrabat S, Laamari K, et al. Necrotizing fasciitis: Fatal evolution of acral melanoma. Orthop Res Traumatol Open J. 2020; 5(1): 1-2. doi: 10.17140/ORTOJ-5-116 Necrotizing Fasciitis: Fatal Evolution of Acral Melanoma Illustration | Volume 5 | Issue 1| 1 Copyright 2020 by El Marfi A. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited. cc Illustration N ecrotizing fasciitis (NF) is a life-threatening soft tissue in- fection characterized by a rapidly spreading infection of the subcutaneous tissue and in particular the fascia. Early diagnosis and radical surgical debridement are required. Surgery is indicated if NF is clinically suspected and must not be delayed by diagnosis in order to reduce mortality. We report a case of NF following surgery of an acral melanoma.1,2 A 73-year-old patient, with a history of type 2 diabetes with a poor glycemic balance, was diagnosed with acral non meta- static pigmented melanoma of the fifth toe (Figure 1) and under- went surgery to excise the tumor. He was seen 10-days later with a painful and acute red leg along with signs of sepsis (fever, hypoten- sion, tachycardia). Dermatological examination found an ill-limited oedematous erythematosus leg with large phlyctenes and necrotic areas extending from the back of the foot to the left leg (Figure 2).
Palpation of the leg found crepitus and hypoesthetic zones. The member’s X-ray showed an infiltration of the soft parts of the leg with the presence of air bubbles (Figure 3). As the diagnosis of necrotizing fasciitis was highly suspected, the patient underwent surgery (Figure 4) for an discharge aponevrotomy. He died hours later due to a septic shock.
Figure 1. Pigmented Tumor of the Fifth Toe Figure 2. Oedematous Erythematosus Leg with Large Phlyctenes and Necrosis Figure 3. X-ray of the Leg Showing Air Bubbles
EL Marfi A et al Orthop Res Traumatol Open J. 2020; 5(1): 1-2. doi: 10.17140/ORTOJ-5-116 PUBLISHERS 2 Illustration | Volume 5 | Issue 1| CONSENT The authors have received written informed consent from the patient.
CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.