DISCUSSION
Gram-negative diplococcus Moraxella is part of the normal human flora of
the upper respiratory tract. It evades the immune system by inhibiting
the T-cell response, it has the ability to evade and survive the host’s
immune responses, a process that particularly helps its ability to
resist the effects of human serum, leading to severe conditions. It is a
life-threatening bacterial disease, involving soft tissue and muscle
fascia. Patients with diabetes mellitus, immunosuppression, malnutrition
and peripheral vascular disease are at higher risk.4-5.
There are very few reports in the literature of soft tissue infection
caused by Moraxella, mainly in the facial region, from orbital and
pre-septal cellulitis to necrotizing fasciitis. 6-7.
The extremities, abdominal wall, and perineum are more frequently
invaded. Its location in the chest wall is extremely rare and the cases
registered have occurred after chest drainage, lung surgery or
esophageal resection.
The diagnosis of this pathology is based on the clinical presentation,
and by means of the surgical visualization of necrosis of the fascia.
Septic shock syndrome is the most feared complication of the
disease8.
Clinicians should be guided by clinical response to antibiotic therapy.
Follow-up is of the utmost importance. On average, treatment for most
lesions requires 10 to 14 days of antibiotic therapy. It should be noted
that following initiation of antibiotic treatment, if there this no
response in five days, this should prompt a change in the antibiotic
regimen or other investigations to verify the
diagnosis9.
Management with negative aspiration therapy offers several advantages
compared to conventional debridement and drainage, resulting in an
excellent therapeutic alternative. Its safe management has been seen in
patients with head, neck and chest wall fasciitis10
In a systematic review of 25 cases of necrotizing breast fasciitis, one
of the therapeutic options is a total mastectomy for adequate control of
the infection. There are a wide variety of reconstruction options with
split-thickness skin grafts being a common choice. Reconstruction of the
defect can be completed within 2 weeks or once the patient is stable and
free of infection11. Partial thickness skin grafts are
indicated for large wounds and can survive in places with little
vascularity such as breast tissue12. Autologous skin
graft provided a reliable option in immediate breast
reconstruction13.