A previously healthy 56 years old male was brought with excruciatingly painful swelling of Rt lower limb, 2 days following trivial trauma to Rt foot.
Examination revealed swelling of entire Rt lower limb, cutaneous necrosis of Rt leg, posterior thigh and gluteal region and absent crepitations on palpation. Plain x-ray of the limb showed soft tissue swelling without gas. Gram staining of aspirate from bullae isolated streptococci in short chains. Urgent bed side fasciotomy revealed extensive myonecrosis sparing the anterior compartment of thigh. Emergency hip disarticulation was performed including excision of entire gluteal compartment. Primary closure was achieved using quadriceps myocutaneous flap based on femoral artery. The patient could be weaned off the ventilatory and inotropic support within 24 hours and was discharged on complete recovery after 2 weeks!DIAGNOSIS: necrotizing myositis!Credit: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
