PubMed · 7209708
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I Smith, B U Beiles. 1980. Cancrum oris [clinical reference].. https://pubmed.ncbi.nlm.nih.gov/7209708/
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Pulmonary gangrene is a rare complication of severe pulmonary infection in which a pulmonary segment or lobe is sloughed. In the English literature, pulmonary gangrene secondary to bacterial infection is uncommon, and fewer to other etiologies. Characteristic roentgen patterns of a mass within a cavity is the hallmark of this disease, which differentiates from a lung abscess. Some authors have emphasized that surgical resection of the infected lobe is the principal option of treatment. In contrast, some have advocated that patients with pulmonary gangrene can be managed with medical therapy. Recently we successfully treated a case of pulmonary gangrene with appropriate antibiotics and percutaneous small bore catheter drainage, even though the complication of bronchopleural fistula was encountered, which led to prolonged hospitalization. The serial roentgenograms and the pictures of computed tomography (CT) will be demonstrated.
The emergency treatment of Fournier's and perineal gangrene is now well defined and is based on excision of the necrotic tissues and broad spectrum antibiotics combined with hyperbarid oxygen therapy and symptomatic resuscitation measures. However, several procedures have been described for the reconstruction of the excised zones. In the light of one case of Fournier's gangrene, the authors evaluate reconstruction of the penile skin by means of a helical split-skin graft. With a follow-up of one year, the morphological and functional result was excellent. The patient has normal erection and the suture line does not contain any retractile adhesions. The authors therefore consider that this simple, but little known procedure should be part of the urologist's therapeutic arsenal for reconstruction of the penile skin.
Necrotizing soft-tissue infections have been widely recognized for over a century, but they remain a challenging problem in clinical infectious disease. Patterns of disease are clearly apparent, but most are polymicrobial and derive increased virulence from synergy between bacteria. Early recognition and prompt surgical drainage are the keys to successful treatment. Edema extending beyond the area of erythema, skin vesicles, crepitus or air in the subcutaneous tissues, and absence of lymphangitis and lymphadenitis are markers of necrotizing infections, particularly when they occur in patients with serious underlying disease. Empiric broad-spectrum antibiotics, prophylactic heparin, and nutritional therapy are important adjuncts to aggressive "stepwise" surgical debridement. A knowledge of patterns of disease can aid in fine-tuning treatment to decrease morbidity.