Necrotizing soft tissue infection following a peripheral bypass.
BACKGROUND
Necrotizing soft tissue infection (NSTI), formerly referred to as necrotizing fasciitis, is a rare but serious postoperative complication. NSTI following arterial bypass is seen only once in the literature (for a coronary artery bypass) and is not mentioned following peripheral bypass. Although surgical site infections have been studied extensively, there are limited published data on postoperative NSTI and no data for NSTI following peripheral arterial bypass.


METHODS
Here we present the first, to our knowledge, reported instance of an NSTI following a lower extremity peripheral bypass. Despite the continued function of the bypass, the patient became rapidly systemically ill with a focus at the surgical site. Because of prompt surgical debridement, the patient survived this severe infection, though did require an above the knee amputation to control the rapid spread of the disease. The patient, a native of American Samoa, was infected with organisms infrequently associated with NSTI, Morganella morganii and Aeromonas hydrophila. This article discusses the diagnosis and treatment of this rare postoperative complication, along with a brief review of the microbiology of the disease.


CONCLUSIONS
NSTI is a rare but lethal postoperative complication. To our knowledge, this is the first reported case of an NSTI following an arterial peripheral bypass. This patient survived because of prompt and aggressive intervention.
Department of Surgery, Tripler Army Medical Center, Honolulu, HI. Electronic address: Carly.r.richards.mil@mail.mil.
Carly R
CR
Richards
Department of Surgery, Tripler Army Medical Center, Honolulu, HI.
Margaret E
ME
Clark
Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC.
Donnell K
DK
Bowen
Department of Surgery, Tripler Army Medical Center, Honolulu, HI.
Denise
D
Uratake
Department of Surgery, Tripler Army Medical Center, Honolulu, HI.
Farhan
F
Ayubi
Department of Surgery, Tripler Army Medical Center, Honolulu, HI.
Tony
T
Katras
Department of Surgery, Tripler Army Medical Center, Honolulu, HI.
Dwight C
DC
Kellicut
D016980:Aeromonas hydrophila / Q000302:isolation & purification*; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001705:Bioprosthesis / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D015925:Cryopreservation; D003646:Debridement; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D008297:Male; D020613:Morganella morganii / Q000302:isolation & purification*; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000601:surgery*; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
D000900:Anti-Bacterial Agents