難治性咽頭瘻孔に対してPGAシートを併用した閉鎖術が有効であった頸部ガス壊疽例

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  • A Case of Cervical Gas Gangrene with Intractable Residual Pharyngeal Fistula That Was Closed Using a PGA Sheet
  • ナンチセイ イントウロウコウ ニ タイシテ PGA シート オ ヘイヨウ シタ ヘイサジュツ ガ ユウコウ デ アッタ ケイブ ガス エソレイ

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<p>Gas gangrene is a progressive necrotizing soft tissue infection caused by bacteria. Cervical gas gangrene carries a poor prognosis, because of the risk of vital complications such as sepsis, disseminated intravascular coagulation, and descending necrotizing mediastinitis. We report a case of cervical gas gangrene that resolved leaving an intractable residual pharyngeal fistula. A 67-year-old man visited our hospital with the chief complaint of neck swelling. CT showed abscesses with gas, extending from the deep neck spaces to the mediastinum. We performed emergency transcervical and transthoracic drainage of the abscesses and tracheotomy, with administration of broad-spectrum antibiotics. At the same time, we also administered treatment to control glycemia, because the patient was severely diabetic. After drainage of the remaining abscesses and several sessions of debridement to remove the necrotic tissues, the patient recovered from the gas gangrene, but had an intractable residual pharyngeal fistula which failed to close even after two attempts at primary closure. We then sutured the fistula and covered it with a polyglycolic acid (PGA) sheet and fibrin glue. This led to effective closure of the fistula and the patient was discharged with moderate dysphagia. PGA is a biocompatible material that is used to cover mucosal defects. A PGA sheet not only useful to reinforce sutures, but also activates both proliferation of fibroblasts and formation of granulation tissue to enhance wound healing. Our results suggest that use of a PGA sheet is effective to close intractable pharyngeal fistula.</p>

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