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患男,25岁,入院10d前施工中不慎从高处摔下,致左胫腓骨中下段开放性骨折,在当地县医院行清创,骨折内固定。术后5d伤口感染,行扩创引流,分泌物稀薄、暗红、恶臭,第7日出现左足及整个小腿肿胀、剧痛,创口周围部分肌肉发黑,足背动脉搏动不能触及,于第8日行左小腿筋膜室及左足背皮肤切开减压,发现肌肉发黑,无弹性,并且皮下有气泡,未引起重视。病人因持续高烧、心悸、胸闷,左下肢剧痛不缓解且昏厥1次,转来我院。查体:T39.5℃,P120次/min,R29次/min、Bp17/9.5kPa,精神差,左下肢广泛皮下气肿,有明显捻发感,左足肿胀、青紫、发凉,无感觉;左小腿及大腿中下段肿胀,广泛瘀斑,创口内流出暗红色浆液性液体,恶臭,周围可见肌肉发黑坏死。左下肢肌肉无张力,
Male, 25 years old, admitted to the hospital 10d before construction fell accidentally from the height, caused by open fractures in the middle and lower left tibia and fibula, debridement at the local county hospital, fracture fixation. The wounds were infected 5 days after operation. The wounds were expanded and drained. The secretions were thin, dark red and stench. On the 7th day, the left foot and the entire lower leg appeared swollen and severe pain. The muscles around the wound were black and the dorsalis pedis artery beat could not be touched. Japanese left fascia left fascia and left foot skin incision decompression and found muscle black, inelastic, and subcutaneous bubbles, did not pay attention. Patients due to sustained high fever, palpitations, chest tightness, left lower extremity pain does not ease and fainting 1, transferred to our hospital. Physical examination: T39.5 ℃, P120 beats / min, R29 beats / min, Bp17 / 9.5kPa, poor spirit, extensive subcutaneous emphysema in the left lower extremity, obvious twisting sensation, left foot swelling, bruising, Left leg and lower thigh swelling, a wide range of ecchymosis, wound out of dark red serous liquid, stench around the visible black muscle necrosis. Left leg muscles without tension,