Synergistic necrotizing cellulitis resulting from peri-tonsillar abscess

1996 ◽  
Vol 110 (9) ◽  
pp. 887-890 ◽  
Author(s):  
P. J. Hadfield ◽  
M. Motamed ◽  
G. W. Glover
Keyword(s):  
Necrotizing Fasciitis ◽  
Head And Neck ◽  
Broad Spectrum ◽  
Early Recognition ◽  
Surgical Debridement ◽  
Successful Outcome ◽  
Prompt Treatment ◽  
Intravenous Antibiotics

This case demonstrates the rare but potentially fatal condition of synergistic necrotizing cellulitis of the head and neck. Although similar to necrotizing fasciitis, this is more extreme as it also destroys muscle. Peri-tonsillar abscess is a recognized cause, but has not previously been described in this country, however it is a condition commonly referred to otolaryngologists and awareness of the complication of synergistic necrotizing cellulitis is necessary to allow early recognition and prompt treatment. This should be by broad-spectrum intravenous antibiotics with extensive surgical debridement and drainage procedures repeated as necessary. Although this case had a successful outcome, many patients do not survive, particularly if treatment is delayed or inadequate.

scholarly journals “The Clock Is Ticking”: The Timely Management of a Painful Skin Rash in a Seventy-Year-Old Woman

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Susan Thomas ◽  
Folashade Omole ◽  
Vijaykumar G. Patel ◽  
Michelle L. Nichols
Keyword(s):  
Septic Shock ◽  
Necrotizing Fasciitis ◽  
Skin Rash ◽  
Broad Spectrum ◽  
The Body ◽  
Surgical Debridement ◽  
Erythematous Rash ◽  
Intravenous Antibiotics

Necrotizing fasciitis is an uncommon but a potentially fatal condition and can affect any part of the body. Most patients have pre-existing conditions that render them susceptible to infection, although etiology is unclear. Diagnosis is primarily clinical and is often delayed because of the unfamiliarity of the condition among clinicians. Management consists of immediate resuscitation, early surgical debridement, and administration of broad spectrum intravenous antibiotics. We report a case of a 70 year old woman who presented with a painful erythematous rash, was admitted as a case of cellulitis, later developed worsening of symptoms and septic shock, and was diagnosed as necrotizing fasciitis.

Surgical debridement of craniocervical necrotizing fasciitis: the window of opportunity

2006 ◽  
Vol 120 (8) ◽  
pp. 702-704 ◽  
Author(s):  
B C Hanna ◽  
T G Delap ◽  
K Scott ◽  
S Sinclair
Keyword(s):  
Necrotizing Fasciitis ◽  
Early Recognition ◽  
Late Presentation ◽  
Surgical Debridement ◽  
Thoracic Wall ◽  
Prognostic Indicators ◽  
High Morbidity ◽  
Window Of Opportunity ◽  
The Face ◽  
Advanced Stages

Craniocervical necrotizing fasciitis (CCNF) has a potentially high morbidity and mortality. Late presentation, shock and disseminated intravascular coagulation are associated with a particularly poor prognosis. Early recognition and aggressive treatment is advised. A case report is presented of a late presentation of necrotizing fasciitis of the face, neck and anterior thoracic wall. Despite adverse prognostic indicators, surgical debridement was performed. Intensive medical treatment included continuous renal replacement therapy and intravenous immunoglobulin. Survival in this case illustrates that the window of opportunity for surgically treating CCNF extends to the advanced stages of the disease, albeit with increased morbidity.

Surgical debridement and adjunctive hyperbaric oxygen in cervical necrotizing fasciitis

2009 ◽  
Vol 140 (5) ◽  
pp. 730-734 ◽  
Author(s):  
Carrie E. Flanagan ◽  
Opeyemi O. Daramola ◽  
Robert H. Maisel ◽  
Cher Adkinson ◽  
Rick M. Odland
Keyword(s):  
Necrotizing Fasciitis ◽  
Hyperbaric Oxygen ◽  
Case Series ◽  
Surgical Debridement ◽  
Diabetic Patients ◽  
Intravenous Antibiotics ◽  
Computed Tomography Scans ◽  
Aggressive Medical Management ◽  
Length Of Hospitalization ◽  
Combined Data

Objective: To review our management of cervical necrotizing fasciitis (CNF) with the use of adjunctive hyperbaric oxygen therapy (HBO). Study Design: Case series with chart review. Subjects and Methods: Evaluation of ten patients with CNF between 2001 to 2006. Results: There were five male and six female patients. Mean age was 43 ± 11 years. Eight cases resulted from an odontogenic source. Comorbidities included diabetes mellitus, hypertension, and substance abuse. All patients had computed tomography scans performed, received intravenous antibiotics, and underwent surgical debridement. Eight patients underwent surgery within 24 hours. The average number of debridements was 2.2 ± 0.8. Hospitalization was twice as long for diabetic patients (15.5 ± 8.16 days) compared with nondiabetic patients (7.5 ± 1.6 days, P = 0.029). Nine patients had HBO therapy. Combined data revealed a possible decrease in length of hospitalization with HBO therapy ( P < 0.001). No mortality was documented. Conclusion: In addition to early and aggressive medical management and surgical debridement, this study suggests that HBO therapy is a beneficial adjunct by potentially decreasing length of hospitalization. Randomized trials are still needed to demonstrate its efficacy.

scholarly journals Gemella morbillorum as a source bacteria for necrotising fasciitis of the torso

2020 ◽  
Vol 13 (1) ◽  
pp. e231727
Author(s):  
Gustavo Romero-Velez ◽  
Xavier Pereira ◽  
Anil Narula ◽  
Peter K Kim
Keyword(s):  
Soft Tissue ◽  
Operating Room ◽  
Soft Tissue Infection ◽  
Broad Spectrum ◽  
Surgical Debridement ◽  
Soft Tissue Infections ◽  
Imaging Findings ◽  
Oral Antibiotics ◽  
Intravenous Antibiotics ◽  
Necrotising Soft Tissue Infections

A 66-year-old man presented with upper back cellulitis and imaging findings consistent with a necrotising soft tissue infection. He was started on broad-spectrum intravenous antibiotics and was taken to the operating room for immediate surgical debridement. On postoperative day 5, the culture was noted to be growing Gemella morbillorum, an exceedingly rare cause of necrotising soft tissue infections in immunocompetent hosts. His condition improved, and he was transitioned to oral antibiotics and discharged home.

scholarly journals Necrotizing Fasciitis Case Series: Improved Outcomes with Early Diagnosis and Effective Surgical Interventions in Low Resource Settings

2018 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Fluid Resuscitation ◽  
Broad Spectrum ◽  
Community Hospital ◽  
Case Series ◽  
Surgical Debridement ◽  
Necrotising Fasciitis ◽  
Surgical Interventions ◽  
Improved Outcomes

Necrotizing fasciitis (NF) is a severe, rare, potentially lethal and fulminant soft tissue infection. It is marked by necrosis of the superficial fascia, neutrophil infiltration of the deep dermis and fascia, thrombosis of the cutaneous microcirculation, and the presence of the infecting organism in the necrotic tissue. The infection progresses rapidly with systemic signs of toxicity and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%). Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, and in poor resource settings. Early and aggressive meticulous surgical debridement constitutes the mainstay of treatment along with broad spectrum antibiotics and fluid resuscitation. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. Objective: To determine improved outcomes with early diagnosis and cost effective surgical interventions for patients necrotizing fasciitis at Bwindi community hospital,Uganda. Design: These are case series of 6 patients who presented with fulminant necrotising fasciitis admitted to the hospital through the emergency wing. Materials and methods: Six patients presented with fulminant nectrozing fasciitis admitted at Bwindi community Hospital between August 2015 and June 2017, were analysed, and appropriate effective surgical management based on these patients is suggested. Results: These patients were all admitted after a minimum of 3.8 days from the on onset of the infection. The average timing of debridement through fish fillet incisions was 14 and 4 hours from the time of admission and diagnosis respectively. The average number of redebreidments were six. There was 83.3% survival after treatment, with 16.6% mortality. Vacuum dressings were used for one paediatric case. 50% of the wounds healed by secondary intention, 16.6% by secondary closure and 16.6% done full thickness skin grafting. Placement of the testicles in subcutaneous pockets in the thigh was done for one patient. In 100% were of the patients dressing with honey gauze was used for the alternate day bed side dressing. Conclusion: The diagnosis of necrotising fasciitis is a challenge, however early meticulous surgical debridement, supported by fluid resuscitation and broad spectrum antibiotic clinical administration is key to survival of these patients.

Cervicofacial necrotizing fasciitis: can we expect a favourable outcome?

2004 ◽  
Vol 118 (10) ◽  
pp. 771-777 ◽  
Author(s):  
Naresh K. Panda ◽  
Sridhar ◽  
Suryanarayana Rao Sridhara
Keyword(s):  
Antibiotic Therapy ◽  
Necrotizing Fasciitis ◽  
Head And Neck ◽  
Primary Source ◽  
Favourable Outcome ◽  
Surgical Debridement ◽  
Source Of Infection ◽  
Total Hospital Stay ◽  
Gram Negative Organisms ◽  
Aerobic And Anaerobic

Necrotizing fasciitis of the head and neck is an uncommon, progressive, destructive soft tissue infection of mixed aerobic and anaerobic organisms, having high mortality if left untreated (22 to 100 per cent). This study makes an attempt to analyse various factors and management methods determining the overall prognosis.A retrospective analysis of all cases of necrotizing fasciitis involving the head and neck, with exclusion of those involving the eyelid and the scalp, was undertaken. Various parameters such as demography, aetiology, complications, management and outcome were studied.Males outnumbered the females with the latter having a greater risk of involvement after 60 years. Odontogenic infection was the primary source of infection. Anaerobes were cultured in seven out of 17 cases, with six others showing mixed Gram positive and Gram negative organisms. Anaemia was the most commonly associated illness, with diabetes affecting four out of 17 cases.Aggressive surgical debridement with triple antibiotic therapy was used in the management of necrotizing fasciitis with an overall mortality of 11.8 per cent. Patients having late referral, anaemia and one or other complication had increased duration of total hospital stay.Better results can be obtained with proper control of infection by early diagnosis, aggressive surgical debridement and triple antibiotic therapy, along with timely control of complications and associated illnesses.

Postoperative Necrotizing Fasciitis in Children

PEDIATRICS ◽  
1988 ◽  
Vol 82 (6) ◽  
pp. 874-879
Author(s):  
Leo D. Farrell ◽  
Stephen R. Karl ◽  
Paul K. Davis ◽  
Mark F. Bellinger ◽  
Thomas V. N. Ballantine
Keyword(s):  
Necrotizing Fasciitis ◽  
Surgical Procedures ◽  
Broad Spectrum ◽  
Subcutaneous Tissue ◽  
Failure To Thrive ◽  
Skin Grafting ◽  
Antibiotic Use ◽  
Surgical Debridement ◽  
Superficial Fascia ◽  
Clean Contaminated

Necrotizing fasciitis is a rapidly progressive soft tissue infection, involving the skin, subcutaneous tissue, and superficial fascia. It is a rare but life-threatening complication in the postoperative patient. In the last 7 years, we have treated four children in whom necrotizing fasciitis developed after appendectomy for ruptured appendix, bilateral inguinal herniorrhaphy, or gastrostomy closure. These four patients and seven well-described children from the literature with necrotizing fasciitis following surgery form the basis of this review. The ages ranged from six days to 15 years (ean 4.5 years). There were eight boys and three girls. There were five clean, five clean-contaminated, and one contaminated surgical procedures. No patient had evidence of malignancy or diabetes. Two of our four patients had evidence of failure to thrive. Only one patient had an intraabdominal abscess. In ten, the infection started in the abdominal wall; in one, the infection started in the chest wall. In our four patients, three had neutropenia and fever, four had tachycardia, and two had wound crepitation and radiographic evidence of subcutaneous gas. Cultures of all ten wounds were positive for bacteria; six were positive for more than one organism. Blood culture results were positive in five of five patients who died and in only two of five patients who survived. All survivors had wide surgical debridement and were treated with broad-spectrum antibiotics. The mortality rate was 45% in the whole series. In our four patients, the only death occurred in a child with Down syndrome and failure to thrive whose parents refused further therapy. Necrotizing fasciitis may complicate clean surgical procedures in children without risk factors. Septicemia is a late and ominous sign. Early wide surgical debridement and broad-spectrum antibiotic use are necessary for survival. Skin grafting is often required for late coverage of these defects.

scholarly journals Management of Necrotizing Fasciitis with Proximal Tibia Fracture

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Shubhankar Patil ◽  
Dilip Kumar ◽  
Karthik Rao ◽  
Navratan Dipu
Keyword(s):  
Necrotizing Fasciitis ◽  
High Mortality ◽  
Broad Spectrum ◽  
Proximal Tibia ◽  
Road Traffic ◽  
Group A Streptococcus ◽  
Tibia Fracture ◽  
Surgical Debridement ◽  
Proximal Tibia Fracture ◽  
Broad Spectrum Antibiotics

Introduction: Necrotizing fasciitis is a rare disease of soft tissue infection with a high mortality. It is characterized by rapidly spreading inflammation and necrosis of fascial planes. It usually follows an injury, though the cause may be a small abrasion or an insect bite or surgical incisions. It is commonly caused by bacteria such as Group A streptococcus. It may be accompanied by septic shock. It causes rapid death unless it is diagnosed quickly and managed aggressively. Prompt surgical debridement must be done to reduce mortality. Rapid diagnosis, antibiotic therapy, fluid resuscitation, and surgical debridement of the infection are all needed in the management of this fatal disease. However, when necrotizing fasciitis is associated with an underlying fracture the treatment becomes even challenging and limb-threatening. Case Report: A 48-year-male patient of South Asian descent came to Emergency Room with history of road traffic accident and sustained injury to the right (RT) leg. He was admitted with pain, swelling and blisters of the RT leg and suspected to have necrotizing fasciitis with proximal tibia fracture of the RT leg. He was treated with thorough surgical debridement, broad-spectrum antibiotics, free flap, and Masquelet’s technique with limb reconstruction system (LRS). At 18 months of follow-up the fracture healed, LRS was removed, pin tracts healed and patient was able to walk without any support. Conclusion: Necrotizing fasciitis is rare, rapidly progressive disease with a high mortality rate which requires prompt diagnosis, early surgical debridement, broad-spectrum antibiotics, careful fluid, and electrolyte management. These patients require a combined multidisciplinary approach for their management. Keywords: Necrotizing fasciitis, proximal tibia fracture, surgical debridement.

scholarly journals Cervical Necrotizing Fasciitis of Odontogenic Origin in a Diabetic Patient Complicated by Substance Abuse

2014 ◽  
Vol 25 (1) ◽  
pp. 69-72 ◽  
Author(s):  
Rubens Camino Junior ◽  
Maria G. Naclerio-Homem ◽  
Lecy Marcondes Cabral ◽  
João Gualberto C. Luz
Keyword(s):  
Substance Abuse ◽  
Antibiotic Therapy ◽  
Diabetic Patient ◽  
Necrotizing Fasciitis ◽  
Broad Spectrum ◽  
Surgical Debridement ◽  
Response To Treatment ◽  
Rapid Progression ◽  
Broad Spectrum Antibiotic ◽  
Odontogenic Origin

Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridement. Necrosis in the platysma muscle was verified by histopathologic analysis. Reconstructive surgery was performed after suppressing the infection, and the wound was closed with an autologous skin graft. The patient had a long hospital stay, in part because the substance abuse led to a difficult recovery. The principles of early diagnosis, aggressive surgical debridement, broad-spectrum antibiotic therapy and intensive supportive care in the treatment of CNF were confirmed in the present case. It was concluded that given the occurrence of CNF in the presence of diabetes mellitus and abuse of substances such as alcohol and tobacco, the health care professional should consider a stronger response to treatment and longer hospitalization.

scholarly journals Surgical management of necrotizing fasciitis due to odontogenic infection with sepsis: a case report

2017 ◽  
Vol 2 (1) ◽  
pp. 70
Author(s):  
Saka S. Nugroho ◽  
Endang Syamsudin ◽  
Andri Hardianto ◽  
Lucky Riawan
Keyword(s):  
Necrotizing Fasciitis ◽  
Broad Spectrum ◽  
Odontogenic Infection ◽  
Surgical Debridement ◽  
Team Approach ◽  
Surgical Operation ◽  
Empiric Antibiotic ◽  
The Face ◽  
Facial Area ◽  
Empiric Antibiotic Treatment

Objective:To perform surgical operation on necrotizing fasciitis due to odontegenic infection with sepsis.Methods: In this case an odontogenic infection was accompanied by a large open wound on the face and sepsis. Patient was hospitalized in the Dr.HasanSadikin General Hospital. Management of this patient in the emergency room were administration of appropriate broad-spectrum empiric antibiotic, incision and pus drainage, and extraction of the infected tooth, followed by fluid resuscitation with strict observation. Surgical debridement was then performed.Results:After being treated for 12 days the patient’s condition improved. We planned closure of defects of the facial area, but the patient refused.Conclusion: Necrotizing fasciitis is an uncommon but potentially lethal condition associated with high rates of morbidity and mortality. Early diagnosis coupled with emergent surgical debridement, appropriate broad-spectrum empiric antibiotic treatment, and a multidisciplinary team approach is essential for successful treatment.

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