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Aim: Nicolau syndrome (NS) is the necrosis of skin and subcuticular tissue, followinginjection of many drugs, which covers nearly a perforasome. This study aims to unveil ourclinical approach and treatment alternatives against this rare pathology subsequent todiclofenac sodium.Material and Methods: In this retrospective study, our approach to 16 patients who developedNS at the injection site after diclofenac sodium injection was evaluated. Patients’ demographicdata, concomitant diseases, location and size of necrosis, and surgical techniques werecollected. Post-operative complications, hospitalization period and results were evaluated.Results: There were total of 16 patients, 2 of which were male and 14 were female. The meanage was 60±14.4 years, and the mean body mass index (BMI) was 33±1.4 kg/m2. The majorconcomitant comorbidity was diabetes mellitus, followed by primary hypertension. The meandefect size was 8x8x5 cm. Surgical debridement was applied to all 16 necrosis. Following thesurgical debridement of necrosis, 8 patients were reconstructed with primary closure, 6 patientswith fasciocutaneous flaps and 2 patients with delayed primary closure after a week. Allpatients heal completely without complications.Conclusion: Utmost care must be given when performing diclofenac sodium injections to thepatients with comorbidities, such as high BMI, diabetes mellitus, and primary hypertension.The caregiver must be certain that the needle is in the muscular plane and no perforator vesselto be harmed during this procedure. In case of a post-injection necrosis, an early interventionwith surgical debridement and reconstruction is an efficient treatment. |
