PMC7710500_01
Initial findings in first surgical wound cleansing and debridement showing extensive soft tissue necrotizing infection with deep tissue penetration around sites of prior liposuction and fat graftings injection.
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Upon admission to our institution, she persisted with septic shock that required vasopressor support and mechanical ventilation; multiple and extensive lesions ranging from the pelvis to the neck were observed with the presence of subcutaneous emphysema, leakage of purulent material, erythema and necrosis at the wound edges (Fig. 1).
CT Scan showing subcutaneous emphysema extending from the soft tissues of the thorax to the iliac crests.
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The air dissected some of the muscular planes and striation of subcutaneous fatty tissue was also identified at the thoracic and predominantly abdominopelvic level (Fig. 2, Fig. 3, Fig. 4 ).
Axial CT scan shows subcutaneous emphysema in the fat surrounding the abdominal oblique muscles (thick white arrow) the iliac bones (thin white arrow) and paravertebral muscles (blue arrows).
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The air dissected some of the muscular planes and striation of subcutaneous fatty tissue was also identified at the thoracic and predominantly abdominopelvic level (Fig. 2, Fig. 3, Fig. 4 ).
Results after the first wound cleansing, debridement, dressing and starting of negative pressure wound therapy.
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Intra operative image showing extensive wound debridement with multiple areas of necrotic tissue extending to the muscular fascia.
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Wound edges re-aproximation by delayed primary clousure with a partial skin graft after 13 previous debridement and advancements.
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