Abstract
Necrotizing fasciitis has a very high acute mortality. Diabetes mellitus often underlies the disease. In this paper, we report two cases of necrotizing fasciitis caused by sacral decubitus, which were successfully treated with withdrawal of pus through radical excision, cleansing and debridement. The patients were: a 74-year-old man with a history of diabetes and depression (case 1) and a 82-year-old man with a history of diabetes and spinal injury which resulted in paraplegia (case 2). In either case, a wide area extending from the buttocks to lower back was cut open for drainage, washing and debridement at an early stage after the onset of necrotizing fasciitis, and broad-spectrum antibiotics were administered. Due to preoperative general health conditions, underlying diseases such as diabetes mellitus and postoperative diapedesis of protein, the patients' nutritional status critically deteriorated after surgery. Consequently, measures were taken to control diabetes and provide nutritional care. These efforts were crowned with success. It was found that early healing of surgical wound necessitated using pressure dispersion type mattresses and turning, on a regular basis, of the bed-ridden patients with decreased mobility, in addition to putting them in rehabilitation.
