Neurofibroma: Types, Clinical Features, Complications, and Treatment Options

Necrotizing Fasciitis

Write briefly on necrotizing fasciitis or subdermal gangrene.

Answer. It is defined as rapidly progressing necrosis of subcutaneous tissue and fascia usually sparing the muscles and accompanied by toxicity, high fever and apathy.

“Preventing Complications From Neurofibromas”

Etiology

Bacteria such as Streptococcus pyogenes, anaerobes, coliforms,Gram-negative organisms

Types

• Type I: Polymicrobial (80%): Mixed infection; by non—group A streptococci with anaerobes or clostridial or enterobacteriaceae (E coli, Pseudomonas).
  It is common in perineum, trunk and postoperative wounds; common in diabetics and immunosuppressed people.
• Type II: Monomicrobial: It is due to group A hemolytic streptococci or methicillin-resistant Staphylococcus aureus (MRSA).
  It is common in young individual; common in extremities without any comorbid status.
• Type III: It is Gram-negative rod (Vibrio vulficus) after a minor trauma; associated with chronic liver disease,diabetes, steroid therapy, chronic kidney disease. It is rare.
• Type IV: It is due to fungal infection commonly, Aspergillus zygomycetes. it is also rare.

“Types Of Neurofibromas Explained”

Predisposing Factors

• In old age
• In smokers
• Diabetics
• Immunosuppressed individuals
• Malnourished
• Obesity
• Patients on steroid therapy
• HIV patients.

“Recovery Process After Neurofibroma Surgery”

Clinical Features

• Lesion occurs in limbs, lower abdomen, groin and perineum.
• Presence of sudden swelling and pain in part with edema,discoloration, necrotic areas and ulceration.
• Presence of foul-smell discharge
• Presence of high-grade fever with chills and hypotension
• Oliguria with acute renal failure due to tubular necrosis.

“Clinical Features Of Neurofibromas”

• Jaundice.
• Rapid spread in short period (in few hours).
• Features of multiple organ dysfunction syndrome with drowsy, ill-patient.
• Condition, if not treated properly may be life-threatening.
• The subdermal spread of gangrene is always much more extensive than appears from initial examination.

“Dealing With Discomfort Caused By Neurofibromas”

Management

• IV flids, fresh blood transfusion.
• Antibiotics depend on culture and sensitivity or broadspectrum antibiotics. High-dose penicillins are very effctive.
  Clindamycin, third-generation cephalosporins, aminoglycosides are also often needed.
• Catheterization and monitoring of hourly urine output.
• Electrolyte management and monitoring.

“The Role Of Imaging Tests In Diagnosing Neurofibromas”

• Control of diabetes, if patient is diabetic.
• Oxygen, ventilator support, dopamine, dobutamine supplements, whenever required.
• Radical wound excision of gangrenous skin and necrosed tissues at repeated intervals.
• The vacuum-assisted dressing is given.
• Once patient recovers and healthy granulation tissue appears split skin grafting is done. Mesh graft is needed.