The Surgical Treatment of Tissue Necrosis due to Diclofenac Sodium Injection (Nicolau Syndrome)

Abstract

Aim: Nicolau syndrome (NS) is the necrosis of skin and subcuticular tissue, following injection of many drugs, which covers nearly a perforasome. This study aims to unveil our clinical approach and treatment alternatives against this rare pathology subsequent to diclofenac sodium.
 Material and Methods: In this retrospective study, our approach to 16 patients who developed NS at the injection site after diclofenac sodium injection was evaluated. Patients’ demographic data, concomitant diseases, location and size of necrosis, and surgical techniques were collected. 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 mean age was 60±14.4 years, and the mean body mass index (BMI) was 33±1.4 kg/m2. The major concomitant comorbidity was diabetes mellitus, followed by primary hypertension. The mean defect size was 8x8x5 cm. Surgical debridement was applied to all 16 necrosis. Following the surgical debridement of necrosis, 8 patients were reconstructed with primary closure, 6 patients with fasciocutaneous flaps and 2 patients with delayed primary closure after a week. All patients heal completely without complications.
 Conclusion: Utmost care must be given when performing diclofenac sodium injections to the patients 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 vessel to be harmed during this procedure. In case of a post-injection necrosis, an early intervention with surgical debridement and reconstruction is an efficient treatment.