ポケットを有する難治性皮膚潰瘍の治療，および滲出液の多い潰瘍における植皮術の2症例に対して陰圧閉鎖療法を用いて，それぞれ良好な結果を得ることができた。本法の効果として皮膚潰瘍の治療においては，確実な滲出液のドレナージと適切な湿潤環境の保持が得られて潰瘍の治癒を促すことができた。植皮片の固定に際しては，前述の内容に加えて植皮片を確実に密着させることができた。

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Streptococcal toxic shock-like syndrome (streptococcal TSS) develops suddenly and causes disseminated intravascular coagulation, necrotizing fasciitis, septic shock, and multiple organ failure. The mortality rate of streptococcal TSS is higher than 40%. We report a case of streptococcal TSS that developed from a self-bite to the right buccal mucosa. A 70-year-old man was admitted to our hospital with severe swelling of the buccal region caused by self-biting the right buccal mucosa. On the next day, septic shock developed, followed by multiple organ failure. Streptococcus pyogenes was detected on a blood examination after a 5-day culture, and streptococcal TSS was diagnosed. The patient underwent debridement of the right buccal mucosa, was given antibiotics, and received glucose-insulin therapy and hypertensive chemotherapy in the intensive care unit for 10 days. He achieved complete recovery on day 46 of admission. He returned to his work, and streptococcal TSS has not recurred.

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Streptococcal toxic shock syndrome （STSS） can develop suddenly and cause septic shock, which rapidly progresses to multiple organ failure. The focus of the infection is often observed in the extremities and rarely occurs in the head or neck region. The patient was a 63-year-old woman who was referred to our department by a nearby dental clinic because of swelling beneath the jaw and pain radiating to the submental region. We administered ampicillin and clindamycin phosphate after diagnosing neck phlegmon and performed an abscess incision under general anesthesia. The patient went into shock while under postoperative supervision in the intensive care unit, and liver failure, renal failure, and disseminated intravascular coagulation developed. STSS was diagnosed after group A streptococcus was detected on bacterial culture of exudate taken from regions near the incision that was made during surgery. Antibiotics were administered, and the region of the incision was cleaned. The patient recovered well and was discharged from the hospital on day 39. One year after discharge, the patient is currently under follow-up observation at an outpatient clinic, has had no relapse to date, and is in good condition.

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37歳，男性。40℃の発熱，右前額部の紅斑，腫脹が出現し，入院した。直後に腎不全，DICが判明し，急激なショック症状を来した。右眼瞼縁壊死部分の浸出液よりA群溶連菌抗原迅速検出キットで陽性反応を示したため，toxic shock-like syndrome (TSLS) と診断し，人工呼吸器管理下でカテコラミン投与，血漿交換および持続血液濾過透析を開始した。集中治療に加え，ペニシリンGおよびクリンダマイシンの投与を行い，全身状態は改善した。この抗原迅速検出キットは迅速性，感度および特異度から，TSLSの早期診断に極めて有用であり，自験例では患者の救命に寄与したと考えられた。

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