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A Basic Algorithmic Surgical Approach for Nicolau Syndrome
Ali Yeniocak1, Osman Kelahmetoğlu1, Mustafa Özkan2
1Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakıf University, Istanbul, Turkey.
Journal of Cutaneous and Aesthetic Surgery
|August 15, 2020
Summary
Nicolau syndrome (NS), a rare complication from diclofenac injections, was studied in 11 patients. Surgical debridement and tissue repair showed satisfactory aesthetic and functional outcomes, suggesting varied treatment approaches are effective.
Area of Science:
- Dermatology
- Plastic Surgery
- Pharmacovigilance
Background:
- Nicolau syndrome (NS) is a rare but severe adverse event following intramuscular injections, particularly diclofenac sodium.
- The condition involves ischemic necrosis of the skin and subcutaneous tissue.
- Understanding the etiology and treatment of NS is crucial for patient management.
Purpose of the Study:
- To evaluate the etiology and surgical treatment outcomes of 11 patients diagnosed with Nicolau syndrome.
- To develop a foundational algorithm for surgical management of NS.
- To analyze literature data on NS treatment strategies.
Main Methods:
- Retrospective evaluation of 11 patients with NS between December 2013 and January 2018.
- Surgical debridement of necrotic tissue was performed in nine patients.
- Tissue defects were reconstructed using fasciocutaneous flaps (n=5) or primary closure (n=4).
Main Results:
- No surgical complications such as infection, dehiscence, seroma, or flap necrosis were observed.
- Patients receiving concurrent antibiotic therapy showed no adverse events during follow-up (2-30 months).
- Surgical interventions resulted in satisfactory aesthetic and functional outcomes.
Conclusions:
- Nicolau syndrome appears more prevalent in women with higher BMI and gluteal fat.
- The study suggests that various medications, not exclusively diclofenac, could potentially trigger NS.
- Diverse surgical techniques offer effective treatment options for NS.
