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Necrotizing fasciitis – a rare complication following common obstetric operative procedures: report of two cases

Authors Medhi R, Rai S, Das A, Ahmed M, Das B

Received 28 October 2014

Accepted for publication 1 January 2015

Published 7 April 2015 Volume 2015:7 Pages 357—360

DOI https://doi.org/10.2147/IJWH.S76516

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Elie Al-Chaer


Robin Medhi, Suditi Rai, Arpana Das, Mansur Ahmed, Banani Das

Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India

Abstract: Necrotizing fasciitis, a near-fatal soft-tissue infection complicating obstetric operative wounds, is a rare entity in obstetrics. Herein, we report two cases of necrotizing fasciitis in severely undernourished and anemic women following obstetric operative procedures. Both undernourishment and anemia compounded the already existing immune-suppressed state in pregnancy and may have lead to life-threatening necrotizing fasciitis. One of the patients developed necrotizing fasciitis following episiotomy and the other following cesarean section. Both the cases were diagnosed clinically. Management was done by total parenteral nutrition, prompt correction of anemia, and surgical debridement under broad-spectrum antibiotic coverage. The raw areas were later reconstructed by split skin grafting in the first case, whereas, in the second case, due to the patient’s refusal of skin grafting, the wound was allowed to heal by secondary intention. Both patients survived, although with morbidity. Our study aims to emphasize prompt correction of comorbidities along with aggressive management of necrotizing fasciitis for better outcomes in the obstetric population. Prompt correction of nutritional status improves the survival rate.

Keywords: anemia, undernourishment, total parenteral nutrition
 

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