PMC4084793_01
Skin manifestation after bagatelle injury on day 11 after admission.
1754-9493-8-28-1.jpg
PMC4084793_01_1754-9493-8-28-1.jpg
F1
Within the next two days, the hematoma rapidly changed to a big untypical necrosis of the skin (day 11 after admission, see Figure 1).
Intraoperative appearance after initial radical debridement on day 11 after admission.
1754-9493-8-28-2.jpg
PMC4084793_01_1754-9493-8-28-2.jpg
F2
Therefore, a surgical exploration was performed immediately (see Figure 2).
Areactive necrosis of subcutaneous fat and fascia without detection of bacteria (H&E, 200x).
1754-9493-8-28-3.jpg
PMC4084793_01_1754-9493-8-28-3.jpg
F3
The initial histopathological report could not confirm the typical picture of necrotizing fasciitis (see Figure 3).
Diagram of the course of disease.
1754-9493-8-28-4.jpg
PMC4084793_01_1754-9493-8-28-4.jpg
F4
It took another six surgical interventions and nearly eight months to finally close all wounds (see Figure 4).