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Hand salvage using a chimeric alt flap following extensive Vibrio vulnificus necrotizing fasciitis: a case report
Đặng Phương Nam1,2, Trần Thiết Sơn1,2,3, Tạ Thị Hồng Thuý1,3
1Department of Plastic and Reconstructive Surgery, Hanoi Medical University, No.1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam.
Background:
Vibrio vulnificus infection is a rare, rapidly progressing condition often acquired through wounds exposed to aquatic environments or marine animals. It can cause septic shock, organ failure, and high mortality. Reports on limb salvage in necrotizing fasciitis caused by V. vulnificus are limited.
Case Presentation:
A 62-year-old Vietnamese male with alcohol use and hepatitis B developed swelling, bullae, and necrosis in his left hand after a tilapia fin injury. He experienced septic shock requiring resuscitation, antibiotics, and ventilation. Cultures confirmed V. vulnificus. Surgery showed necrotizing fasciitis, leading to extensive debridement. Reconstruction used a chimeric anterolateral thigh (ALT) flap and fascia lata flap. At 18 months, his hand improved significantly in function and appearance.
Conclusions:
This case emphasizes the importance of local wound management in severe V. vulnificus infection. Early radical debridement after stabilizing hemodynamics is crucial. A chimeric ALT flap is a key option for one-stage reconstruction of multiple damaged components, ensuring functional and aesthetic hand salvage.