THE ABDOMINAL FLAP - A CHANCE FOR UPPER LIMB RECOVERY (AFTER A DOG BITE) - A CASE REPORT

Luminița Nirlu1, T. Salmen1, A. Beedasy3,Oana Grobnicu2, A. Frunză1,2
1”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2The Emergency Clinical Hospital, Bucharest, Romania
3The Plastic Surgery and Reconstructive Microsurgery, Zetta Clinic, Bucharest, Romania
Corresponding author: Luminita Nirlu
Phone no. 0040724368606
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

A 57-year-old male presents himself at the Emergency Room, 5 days after a dog bite. He is immediately admitted, with indication for surgical treatment for a neglected, septic wound, localized on the left hypothenar eminence, with significant functional impairment. His personal health history includes hypertension and dyslipidemia. Radiocarpal infectious arthritis, pus secretion, fascial-myositis of the left hypothenar eminence and of the left volar region are diagnosed during surgery. The pus is sent to the Microbiology Laboratory for analysis and cultures and an anaerobic germ infection is identified. The damaged tissue is surgically excised, resulting in a skin defect of 10x15 cm. Although there is important tissue removal, amputation of the hand is avoided and the patient’s evolution is fairly good. Postoperatively, wound dressing is performed daily, combined with antibiotherapy, icing and administration of non-steroidal anti-inflammatory drugs. A neglected dog bite can have a dramatic evolution: there is serious potential for aggressive infection, followed by further local necrosis or septicemia. In our case, the evolution was favorable, since amputation was avoided. In order to prevent such instances, an efficient method for addressing small defects is to radically excise the septic tissues, followed by direct suture. In the case of large defects, one can perform an Italian flap, which is normally detached, safely, after three weeks.

Keywords: septic, fascio-myositis, arthritis, pedicled Italian flap

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