PMC6033253_01
(a) Mid-lower back laceration, nonpurulent upon presentation with minimal discharge. (b) Right leg open incision sites after fasciotomy due to the right leg compartment syndrome after trauma.
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Physical examination at presentation revealed an awake, oriented, and cooperative patient with several skin lacerations in the right lower extremity and mid-lower back (Figure 1(a)), right leg open incision sites after fasciotomy (Figure 1(b)), a left thigh lateral incision site, and a left elbow posterior incision site after ORIF.
Progression of necrosis at the amputation stump, requiring further debridement of the necrotic edges.
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The patient's systemic overall deterioration with severe anemia (Hg = 6.4 g/dl), persistent acute renal failure, and necrosis of the edges of the right amputation stump dictated a transfer of the patient to the OR on day 8 after admission and debridement of the necrotic edges of the right amputation stump (Figure 2).
(a) Signs of infection with purulent discharge and progressive expanding necrosis on the left elbow suture line. (b) Posterior and anterior compartment fasciotomies, with inspection of deep necrotic tissues extending from the skin down to the muscles. No twitching seen after cauterization stimuli testing.
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On day 9 of his hospitalization, the left elbow suture line started showing signs of wound infection and progressively deteriorated showing necrotic tissue (Figure 3(a)). The decision was taken to perform anterior and posterior skin release and bicompartmental fasciotomies of the forearm (Figure 3(b)).
Left thigh incision site found to be necrotic with diffuse pyomyositis extending to the anterior and posterior compartment, which lead to performing an aggressive debridement and excision of necrotic tissues that reached the bone.
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Incision and drainage revealed diffuse pyomyositis extending to the anterior and posterior compartment, which lead to performing an aggressive debridement and excision of necrotic tissues that reached the bone (Figure 4).