Arch Craniofac Surg.  2020 Apr;21(2):127-131. 10.7181/acfs.2019.00696.

Klebsiella pneumoniae necrotizing fasciitis on theupper lip in a patient with uncontrolled diabetes

• Kim HS
• Chang YJ
• Chung CH

• KMID: 2500257
• DOI: http://doi.org/10.7181/acfs.2019.00696

Abstract

A 60-year-old woman with a history of diabetes mellitus and chronic renal failure was admitted to the hospital with severe pain in the upper lip, which began 4 days prior to admission, accompanied by a bullous lesion and suspected cellulitis in the upper lip. Immediately after admission, as the patient´s general condition worsened, tests revealed a non-ST elevated myocardial infarction, septic embolism of the lung, as well as septic shock. Her upper lip suddenly presented a gangrenous and necrotic change, which the tissue and blood culture confirmed to be a Klebsiella pneumoniae infection. After a quick response, the patient’s general condition improved. Subsequently, serial debridement was performed to effectively clear away the purulent discharge. While under general anesthesia, the process confirmed full-layer necrosis of the upper lip including the orbicularis oris muscle. Almost half of the entire upper lip sustained a full-layer skin and soft tissue defect, with scar contracture. Six months later, to correct the drooling and lip sealing following the defects, a scar release and an Abbe flap coverage were performed considering both functional and aesthetic aspects. The follow-up revealed a favorable corrective result of the upper lip drooling, and the patient was satisfied from a functional perspective.

Keyword

Fasciitis, necrotizing; Klebsiella pneumoniae; Lips; Pedicled flap; Reconstructive surgery; Shock, septic