Necrotizing Soft Tissue Infection Secondary to Traumatic Perineal Injury with Pelvic Fracture—A Case Report—

Abstract

We encountered a case of extensive necrotizing soft tissue infection following a complicated perineal trauma with a pelvic fracture. The patient, a 59-year-old man, was urgently transported to a local hospital after sustaining a crush injury to the pelvic region from a crane truck accident during work. He was hospitalized with a pubic ramus and sciatic fracture and contusions in the right temple and perineum. On the fourth day post-injury, the patient developed a high fever and foul-smelling purulent discharge from the perineal wound, along with extensive erythema and swelling of the back and thighs. Clinical evaluation confirmed necrotizing soft tissue infection secondary to perineal trauma. Emergency open-wound drainage, debridement of necrotic tissue, and colostomy were performed. The patient was managed in the intensive care unit for approximately two weeks and the infection was treated for more than one month. He underwent four debridement procedures, followed by a successful segmental skin graft. One year post-surgery, the colostomy was closed, and the patient resumed work. Optimal management of traumatic injuries to the buttocks, particularly open perineal wounds with pelvic fractures close to the anus, is crucial.