A case report of facial skin necrosis following COVID-19 infection

Анотація

The article presents data from a clinical case that illustrates potential complications of COVID-19, in particular thrombotic phenomena in the skin and soft tissues, which can lead to necrosis even in the long term. Timely detection and comprehensive treatment provide a chance to avoid deep cicatricial facial deformities. The COVID-19 coronavirus infection, which has emerged in recent years, leads to a number of complications in various organs and systems, in the pathogenesis of which the determining factors are reduced immunity and circulatory disorders. Recently, there have been reports of complications in the maxillofacial region, such as osteonecrosis of the jaws, damage to the mucous membrane, cases of deformation of the facial bones, osteomyelitis, thrombosis of the cavernous sinuses, as well as a tendency to increase in the number of malignant tumors of the maxillofacial region. The aim of the work was to demonstrate a clinical case of facial skin necrosis in a patient who had COVID-19, to improve the diagnostic process, and raise awareness of possible rare complications of coronavirus infection. A clinical case of a patient who was admitted to the Department of Surgical Dentistry from the Intensive Care Unit with complaints of a facial wound that appeared after surgery for extensive swelling of the skin of the right half of the face is described. The COVID-19 test was positive. In a few days, the patient experienced progression of skin and subcutaneous fat necrosis, which led to a soft tissue defect. After the treatment, including surgical interventions and drug therapy, the patient's condition improved. The literature review also addressed the mechanisms of COVID-19 complications, including vasculitis, microthrombosis, and the effect on the immune system, which contribute to the development of necrotic changes. Timely diagnosis and adequate treatment of COVID-19 complications, especially rare manifestations such as skin necrosis, are important to prevent further progression of the pathological process and improve the prognosis for the patient. Close monitoring of patients who have had COVID-19, especially those with risk factors, is key to early detection and effective management of such complications. A 69-year-old patient was admitted to the Department of Surgical Dentistry from the Intensive Care Unit with complaints of a facial wound that developed following surgery for extensive swelling of the skin on the right side of the face. The COVID-19 test was positive. A few days after admission, despite ongoing antibacterial therapy, the wound became covered with extensive necrotic tissue without signs of spontaneous rejection. Due to the size of the affected area, a two-stage necrectomy was performed, followed by free skin grafting harvested from the anterior thigh. The postoperative period was uneventful, and the grafted skin flaps successfully integrated. The patient was discharged for continued follow-up under the care of a family doctor.