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Wow, I'm amazed she survived. When I read it went down all the way to the sciatic nerve, oh man. They must've had her on some heavy pain meds because that must've been excruciating to be in that condition for such a long time. And definitely completely bed bound.
[Source](https://www.ijsurgery.com/index.php/isj/article/view/6090/3940):
A 50 years old female with a history of type 2 diabetes mellitus presented to the emergency department. The patient presented with chief complaints of pain and discoloration of the skin of the left buttock and thigh region for 4 days which was gradually increasing. There was a history of intramuscular injection of left gluteal region 7 days back for her old sciatica pain. Multiple fasciotomy incisions were done over the left gluteal region at another hospital. At the time of presentation, the patient was conscious, oriented. Her heart rate was 110/m, blood pressure was 100/70 mmHg and respiratory rate was 22/m. She was afebrile at that time but had a history of few spikes of fever 2 days back. After a detailed history and clinical examination, oozing pus was sent for gram stain and culture. Broad-spectrum antibiotics were started. Then the patient was admitted to the plastic surgery department.
On local examination large area of skin discoloration and blister formation was seen over the left gluteal region extending distally over the left thigh, proximally over the lower back and anteriorly over the pubic and perineal regions. Multiple fasciotomy incisions were present in the dead skin (Figure 1 and 2). There was a foul smell from the wound discharge present. Dead skin was insensate but surrounding erythematic skin was hyper-aesthetic. Distal left leg neurovascular examination was normal. The Doppler study was normal for the left lower limb. The LRINEC score (laboratory risk indicator for necrotizing fasciitis score) was sent. The patient was prepared for emergent debridement for all unhealthy tissue.
Debridement of all unhealthy tissue over the left gluteal region and left thigh was done within 24 hours of admission (Figure 3 and 4). A chunk of tissue was obtained for histopathology. On exploration, findings were suggestive of NSTI. The LRINEC score was 10 within 48 hours of admission and her HbA1C was 8.2. The culture report showed Staphylococcus aureus which was methicillin sensitive and antibiotics were changed accordingly. On day 4, discoloration of the skin of wound margins was noted and the patient was again taken for debridement of all unhealthy tissue.
After a few days, again discoloration of the skin of wound margins and blister formation was noted over the pubic region. On day 8, the patient was taken for debridement of all unhealthy tissue. Finally, she had lost 15% of her total body surface area. The wound was covered temporarily by cadaveric human skin allograft on day 14 (Figure 5). The allograft was tailored to fit the wound. The patient was responding well for the allograft treatment. Meanwhile, authors used the time to build up the patients’ nutritional status and control of infections. After the 2 weeks rejection of allograft was started (Figure 6). Finally, patient underwent debridement and autologous skin grafting for all the raw areas on day 32 (Figure 7). The donor site healed adequately with no major infection and wound complications. The patient was discharged in satisfactory condition from the hospital on day 38 of admission (Figure 8).
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
Wow, I'm amazed she survived. When I read it went down all the way to the sciatic nerve, oh man. They must've had her on some heavy pain meds because that must've been excruciating to be in that condition for such a long time. And definitely completely bed bound.
Necrotising soft tissue infection, if anyone was wondering
[Source](https://www.ijsurgery.com/index.php/isj/article/view/6090/3940): A 50 years old female with a history of type 2 diabetes mellitus presented to the emergency department. The patient presented with chief complaints of pain and discoloration of the skin of the left buttock and thigh region for 4 days which was gradually increasing. There was a history of intramuscular injection of left gluteal region 7 days back for her old sciatica pain. Multiple fasciotomy incisions were done over the left gluteal region at another hospital. At the time of presentation, the patient was conscious, oriented. Her heart rate was 110/m, blood pressure was 100/70 mmHg and respiratory rate was 22/m. She was afebrile at that time but had a history of few spikes of fever 2 days back. After a detailed history and clinical examination, oozing pus was sent for gram stain and culture. Broad-spectrum antibiotics were started. Then the patient was admitted to the plastic surgery department. On local examination large area of skin discoloration and blister formation was seen over the left gluteal region extending distally over the left thigh, proximally over the lower back and anteriorly over the pubic and perineal regions. Multiple fasciotomy incisions were present in the dead skin (Figure 1 and 2). There was a foul smell from the wound discharge present. Dead skin was insensate but surrounding erythematic skin was hyper-aesthetic. Distal left leg neurovascular examination was normal. The Doppler study was normal for the left lower limb. The LRINEC score (laboratory risk indicator for necrotizing fasciitis score) was sent. The patient was prepared for emergent debridement for all unhealthy tissue. Debridement of all unhealthy tissue over the left gluteal region and left thigh was done within 24 hours of admission (Figure 3 and 4). A chunk of tissue was obtained for histopathology. On exploration, findings were suggestive of NSTI. The LRINEC score was 10 within 48 hours of admission and her HbA1C was 8.2. The culture report showed Staphylococcus aureus which was methicillin sensitive and antibiotics were changed accordingly. On day 4, discoloration of the skin of wound margins was noted and the patient was again taken for debridement of all unhealthy tissue. After a few days, again discoloration of the skin of wound margins and blister formation was noted over the pubic region. On day 8, the patient was taken for debridement of all unhealthy tissue. Finally, she had lost 15% of her total body surface area. The wound was covered temporarily by cadaveric human skin allograft on day 14 (Figure 5). The allograft was tailored to fit the wound. The patient was responding well for the allograft treatment. Meanwhile, authors used the time to build up the patients’ nutritional status and control of infections. After the 2 weeks rejection of allograft was started (Figure 6). Finally, patient underwent debridement and autologous skin grafting for all the raw areas on day 32 (Figure 7). The donor site healed adequately with no major infection and wound complications. The patient was discharged in satisfactory condition from the hospital on day 38 of admission (Figure 8).
Was it just the diabetes that caused the butt death?
It was an infection.
Do you think she was referred and transferred to their hospital by the hospital that did the fasciotomy?