Melanie's Gangrene
Introduction
Introduction to Melanie's Gangrene Melanie gangrene is a progressive skin gangrenous ulcer that occurs after surgery or trauma, with edema around the wound, erythema and refractory as a clinical feature, as described by Brewer and Meleney in 1926. Skin lesions are caused by simultaneous infection with S. aeruginosa and S. aureus. The disease often occurs in chest, abdominal surgery or abdominal abscess, 2 weeks after chest drainage. The pathogens are mainly small aerobic streptococcus and Staphylococcus aureus. In addition, Proteus, Enterobacter, Pseudomonas, and Clostridium can be cultured at the lesion. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: abscess thrombosis vasculitis
Cause
Melanie gangrene cause
(1) Causes of the disease
Skin lesions are caused by simultaneous infection with S. aeruginosa and S. aureus.
(two) pathogenesis
Typical lesions occur near the incision sutures of the abdominal surgery (eg ileal resection, colectomy) or at the placement of the drainage tube. The typical features are: central necrosis (an ulceration), bright red at the periphery, and violet in the middle. Color, skin lesions are almost painful and tender, but patients often have no systemic toxic symptoms such as fever.
Prevention
Melanie gangrene prevention
Due to the long course of the disease, the ulcer surface is deep, and the fish food is restricted for a long time, resulting in malnutrition and decreased resistance. Therefore, high protein, high vitamin, digestible food, egg, milk, fresh vegetables, and more should be given. Fruits and foods rich in collagen, such as thick chicken soup, do not eat spicy and stimulating things, quit smoking and alcohol. Pay attention to the prevention of progressive skin gangrenous ulcers after surgery or trauma.
Complication
Melaner gangrene complications Complications, abscess, thrombosis, vasculitis
Non-specific changes manifested as aseptic abscesses, including venous and capillary thrombosis, hemorrhage, necrosis, and mast cell infiltration. Condensation is an important manifestation. Lymphocytic vasculitis at the edge of activity suggests that the vascular endothelium is an early target organ. Early lesions are similar to Behcet's disease and neutrophilic dermatitis. There are also some polymorphonuclear leukocytes in the infiltrating cells, and there are some epithelial cells and giant cells, especially in chronic cases. Mononuclear cells are significant, and even pathological examination of epithelioid hyperplasia can rule out Milpa disease and deep fungal infections.
Symptom
Melanie gangrene symptoms common symptoms edema toxemia erythema nodules
Typical lesions occur near the incision suture of the abdominal surgery (eg ileal resection, colectomy) or at the placement of the drainage tube, and the fistula exit after the chest wall surgery is performed due to infection of the abdomen or chest (eg, empyema) , or chronic ulcers at the extremities, infection usually occurs 1 to 2 weeks after surgery, initially a localized erythema, edematous tenderness area, followed by a painful superficial ulcer, and gradually enlarged, typical The following characteristics can be seen: central necrosis (ulcerosis formation), bright red at the periphery, violet in the middle, almost all pain and tenderness in the skin lesions, but patients often have no systemic toxic symptoms such as fever, if not treated, the ulcer expands progressively. Finally, a huge ulcer is formed.
Examine
Melanie's gangrene check
The pathogenic bacteria are isolated by secretion culture.
Histopathology: The tissue phase of the ulcer is non-specific, necrosis extends to the dermis, and there is acute or chronic inflammatory infiltration, vasodilation, endothelial cell hyperplasia, and reactive hyperplasia of the epidermis at the edge of the ulcer. It can be diagnosed according to the painful ulcer at the sneak edge and the yellow pus with odor. Histopathology is mainly necrotizing vasculitis, small vessel lumen occlusion, thrombosis, infiltration of inflammatory cells in the wall and degeneration and necrosis, followed by skin ulcers and necrosis.
Diagnosis
Melerney gangrene diagnosis and identification
According to the progressive necrotizing ulcer produced after surgery or trauma, and through the secretion culture, the pathogenic bacteria can be isolated to confirm the diagnosis.
The disease needs to be differentiated from gangrenous pyoderma, venous or arteriosclerotic ulcers and ulcers caused by allergic vasculitis.
Gangrenous pyoderma is characterized by destructive necrotizing, non-infectious skin ulcers, and clinically, sputum-like nodules, pustules, or hemorrhagic bullae. In the case of early nodular erythema or pustules, the disease can be attributed to vasculitis. The tender erythema of the nodule is red at first, and then becomes blue in the center, eventually forming an ulcer. One or more vesicular pustules, similar to acne, folliculitis, transient acantholytic dermatosis or herpes-like dermatitis. Both skin lesions can occur at the same time, and can also change each other. Skin lesions can occur in normal skin or areas of the original skin disease. Painful ulcers on the stalk edge and oozing yellowish green pus with malodor have diagnostic value. Oral high-dose corticosteroids are given once a diagnosis is made.
