Wound management in Nicolau Syndrome after Intramuscular Penicillin Injection :Case Repot

سال انتشار: 1398
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 382

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شناسه ملی سند علمی:

WTRMED06_052

تاریخ نمایه سازی: 5 بهمن 1398

چکیده مقاله:

Nicolau syndrome (NS) is a rare condition caused by intramuscular or intra-articular injection of various medications. Several drugs such as penicillin, nonsteroidal anti-inflammatory drugs, corticosteroids, and local anesthetics have been reported to be the cause of NS. A 7-year-old boy was admitted to the emergency department with swelling and skin lesions on the left lower limb. The patient had symptoms of upper respiratory tract infection for a few days prior to admission to an outpatient clinic. He received intramuscular penicillin in the upper outer quadrant of the left buttock a day before being admitted to our center. The patient developed pain, swelling, blistering and skin discoloration and hematoma the left lower limb and mottling and cyanotic patches on lower left leg immediately after the injection.Arterial consultation was performed and 4 days postoperative ultrasound reperfusion was reported but the lesion was But localized buttock lesion progressed to necrosis and surgical debridement was obtained.After debridement that that tissue control infection used acid acetic 2% then made granulation tissue by negative pressure wound therapy Eight sessions with a NPWT Controlled exudate and infection of wound became contracture edge of wound and smaller size very well. Then, the wound management was done with silver spray and biological and collagen dressings.Finally, after 6 months of care at home, physiotherapy and Electromyography (EMG) at regular intervals, the child was gradually able to move and his claudication improved. It seems that claudication was due to direct injection in the sciatic nerve.METHOD: The case report is wound management by modern dressings.CONCLUTION: The correct method of intramuscular injection (injection in the supralateral part of the gluteal muscle, long enough needle to reach the muscle, Z-track injection) can minimize the risk of NS. Aspirating the syringe prior to the injection and never injecting more than 5 milliliters of drug at one time and one site while using the Z-track method are other precautions that may prevent the risk of NS.In this case, it should be noted that without skin graft and minimal damage was successfully repaired.

کلیدواژه ها:

Nicolau Syndrome ، Intramuscular ، Penicillin ، negative pressure wound therapy ، biologic ، collagen dressings (hyaluronic acid and colactive plus) transparent film silicon ، foam dressing.

نویسندگان

Azar Marbut

BSc, ETnurse of Mofid children hospital, Shahid beheshti university, Tehran, Iran