頭皮部壞死性肌膜炎－病例報告

Necrotizing Fasciitis of the Scalp - Case Report

廖建均(Chien-Chun Liao) ； 謝勇上(Yung-Shang Hsieh) ； 王國榮(Kuo-Rong Wang)

《中華民國耳鼻喉科醫學雜誌》 35卷5期 (2000/09) Pp. 334-339

https://doi.org/10.6286/2000.35.5.334

摘要

壞死性肌膜炎(necrotiaing fasciitis)是一進展快速的嚴重細菌感染，最常見發生的位置在復部、四肢及會陰部，發生於頭頸部之壞死性肌膜炎較少見，而發生於頭皮部位之壞死性肌膜炎則更為少見。我們回顧1950至1999年之英文文獻中，僅有13個頭皮壞死性肌膜炎病例曾被報告過。本科於1998年4月經歷一44歲女性，主訴右側耳後頭皮部分紅腫、疼痛已10多日，檢查發現右耳後有一6*6cm 局部發熱、明顯壓痛之波動性腫塊，緊急顯部電腦斷成顯示右側乳突部皮下腫塊及空氣形成，疑已有膿腫形成，遂進行手術探查，發現大量皮下組織、肌膜的壞死，為典型壞死性肌膜炎之發現，便施行大範圍之右側壞死顯部頭皮及組織切除，處後積極外科擴創及換藥，於一個月後感染得到控制，並施行頭皮辯重建手術，患者經3個月治癒出院。本文除詳盡報告此罕見病例外，並加上文獻13例，就發生原因、頭皮解頗構造、侵犯範圍及治療方式等加以分析討論。其中引起頭皮部份壞死性肌膜炎的原因，大部分皆因頭皮創傷所引起。因此我們認為頭皮傷口之處理，對於初發的頭皮傷口，一個開始即應適當的評估，仔細的清潔傷口及縫合，對於剛感染之傷口給予確實的引流，這些在預防頭題產生如壞死性肌膜炎之破壞性感染是非常有幫助的。

關鍵字

壞死性肌膜炎 ； 頭皮

並列摘要

Necrotizing fasciitis is a seavere and rapidly progressive bacterial infection characterized by extensive necrosis of the subcutaneous tissue and suoerficial fascia with rapid exten-sion to surrounding tissue, resulting in bacteremia, septicemia, shock. Necrotizing fasciitis involving the scalp is uncommon. Only 13 cases of necrotizing fasciitis of the scalp have been reported in the English literature between 1950 nad 1999. In April 1998 we saw a 44-year-old women with a 10 day history of redness and pain over her right retro-auricular temporal scalp.Physical ezamination showed a six by six centimeter fluc-tuant mass with local warmth and tenderness. Computerized tomography scan revealed a soft tissue mass lesion containing multiple air densities in the subcutaneous region of the right temporal and occipital areas. During surgical exploration, massive necrotic change of the subcutaneous tissue and fascia was found, and the necrotic tissue was extensively debrided. After surgery, the wound was debridedseveral times, and the wound infection was brought under control after about one month. The patient was stabilized and discharged about three months later after scalp reconstruction. We present the case and discuss previous reports in the literature covering aspects of etiology, surgical anatomy of the scalp, extension of the infection and treatment. In conclusion, the leading cause of necrotizing fasciitis of the scalp is scalp injury. Thus prevention of necrotizing fasciitis of the scalp requires proper assessment of scalp wounds, meticulous cleaning and closure of all fresh wounds, and definitive drainage of newly infected wounds.

並列關鍵字

Necrotizing fasciitis ； scalp