作者： 洪紹育(Shao-Yu Hung) ； Charles Y. Y. Loh ； 林志鴻(Chih-Hung Lin)*
文章出處： 臺灣整形外科醫學會雜誌 ； 26卷2期 (2017 / 06 / 01) ， P213 - 221
摘要：
一、背景:文獻中尚未見過關於頭頸部腫瘤放射療後繼發性下行性壞死性筋膜炎的紀錄。胸壁的壞死性筋膜炎相對來說並不常見，並且當與患有合併症的患者相結合時，敗血症控制和重建時間的管理可能是困難的。在這組患者中，急性呼吸窘迫綜合徵（ARDS）的治療也相對不明確。
二、目標：我們對這組患者的病程治療進行了觀察和紀錄，並重點介紹了我們的臨床經驗。
三、材料和方法：在評估急性呼吸窘迫綜合徵（ARDS）的當前治療選項以及胸壁壞死性筋膜炎的治療方面，對醫療文獻進行了全面的檢索和閱讀。這裡強調的案例來自我們醫院。
四、結果：本文對急性呼吸窘迫綜合徵（ARDS）和胸壁壞死性筋膜炎的治療策略進行了合理的綜述。我們附上了在患者治療過程中拍攝的臨床照片；討論從案例中了解到且能提供給文獻的證據摘要。文章中還介紹了急性呼吸窘迫綜合徵（ARDS）何時應通過體外心肺支持系統（ECMO）進行管理的時間。我們解決了壞死性筋膜炎清創後重建時間策略的可能變化。我們認為，與癌症醫學“多次擊中”理論保持一致並將創傷性損傷降至最低限度，可以控制全身性炎症，從而降低急性呼吸窘迫綜合徵（ARDS）的風險。
Background: The management of descending necrotizing fasciitis secondary to post-head and neck cancer radiotherapy treatment has not been reported in the literature before. Necrotizing fasciitis of the chest wall is relatively uncommon and when coupled with a comorbid patient, sepsis control and management of timing of reconstruction can be difficult. The management of Acute Respiratory Distress Syndrome (ARDS) is also relatively unclear in this group of patients. Aim and Objectives: We present a review of the management strategies of this group of patients and highlight our experience with a clinical report. Material and Methods: A thorough Medline search of the literature was conducted in evaluating the current management options of ARDS as well as the management of necrotizing fasciitis in the chest wall. The case highlighted here was obtained from our hospital. Results: A rationalized review of the management strategies of ARDS as well as chest wall necrotizing fasciitis are provided in the article. We have attached clinical photographs taken during the course of the patient's treatment. Discussion: Pearls learned from the case as well as a summary of the evidence in the literature are provided. Timing as to when ARDS should be managed by extracorporeal membrane oxygenation (ECMO) are also presented in the article. We address a possible change in strategy of the timing of reconstruction post debridement of necrotizing fasciitis. We feel that in keeping with the 'multiple-hit' theory and keeping traumatic insults to the body to a minimum, systemic inflammation can be managed and hence decreasing the risk of ARDS.
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