Necrotizing Myositis: Operative Technique and Decision to Sacrifice Limb in Order to Save Life
Author(s):
Jess Caine, DO; Ronit Bassa, DO; James Yon, MD; Sue Slone, MD; Philip McIntire, DO
Background: Early recognition and urgent operative management of necrotizing soft tissue infections are of critical importance to reduce morbidity and mortality of this rare but devastating condition. Extensive necrotizing myositis is the rarest and most devastating of all the necrotizing soft tissue infections.
Hypothesis: The strategy of damage control surgery is employed with priority to preserve life and get ahead of a potentially fatal etiology while minimizing operative stress to an already taxed physiologic system.
Methods: We present a case of fulminant necrotizing myositis circumferentially involving the left thigh in a patient on chemotherapy for endometrial cancer and supratherapeutic on coumadin for recent deep venous thrombosis. The final source of the patient’s necrotizing myositis was found to be a diverticular perforation or perirectal abscess that was found to be decompressing through the patient’s femoral canal.
Results: Described is the recognition of disease, decision making, rapid anticoagulant reversal, damage control management at the index surgery with high above the knee amputation, supportive critical care, and reconstruction. The patient has left the hospital and is currently doing well in rehab.
Conclusions: Extensive necrotizing myositis is the rarest and most devastating of all the necrotizing soft tissue infections. Early recognition and urgent operative management of necrotizing soft tissue infections are of critical importance to optimize patient survival and optimization of quality of life through reconstructive techniques.