scholarly journals Necrotizing Fasciitis: Diagnostic Challenges and Current Practices

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Abhishek Vijayakumar ◽  
Rajeev Pullagura ◽  
Durganna Thimmappa
Keyword(s):  
Soft Tissue ◽  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Subcutaneous Tissue ◽  
Scoring Systems ◽  
Risk Groups ◽  
Deep Fascia ◽  
Superficial Fascia ◽  
Diagnosis And Management ◽  
Necrotizing Soft Tissue Infections

Necrotizing fasciitis or necrotizing soft-tissue infections (NSTIs) are infrequent but highly lethal infections. They can be defined as infections of any of the layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle) that are associated with necrotizing changes. At onset, necrotizing fasciitis can be difficult to differentiate from cellulitis and other superficial infections of the skin. In fact, only 15% to 34% of patients with necrotizing fasciitis have an accurate admitting diagnosis. Early diagnosis and management with surgical debridement, antimicrobials, and supportive measures reduce mortality. Even with modern ICU care mortality ranges between 16 and 36%; this is related to delays in diagnosis and comorbidities. Various scoring systems have been developed which help in diagnosis and stratifying patients into risk groups. The present review deals with varied presentation, early diagnosis, and management of necrotizing fasciitis.

Noma and Necrotizing Fasciitis of the Face and Neck

2021 ◽  
Author(s):  
Lauren E. Miller ◽  
David A. Shaye
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Head And Neck ◽  
Subcutaneous Tissue ◽  
Neck Region ◽  
Superficial Fascia ◽  
Soft Tissue Infections ◽  
Head And Neck Region ◽  
Necrotizing Soft Tissue Infections ◽  
The Face

AbstractNecrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.

scholarly journals The study of the prognostic outcome of necrotizing fasciitis patients with and without diabetes mellitus

2021 ◽  
Vol 8 (2) ◽  
pp. 563
Author(s):  
Navjot Kaur ◽  
Seema Mittal ◽  
Sudershan Kapoor ◽  
Arun Gupta
Keyword(s):  
Diabetes Mellitus ◽  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Subcutaneous Tissue ◽  
Morbidity And Mortality ◽  
Deep Fascia ◽  
Superficial Fascia ◽  
Cross Sectional ◽  
Prognostic Outcome ◽  
Aggressive Debridement

Background: Necrotizing fasciitis is highly lethal infection. It can be defined as infection of any layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia or muscle). Early diagnosis and management with identification of co morbidities and treating them brings down the morbidity and mortality rate. To make a full assessment of the cause, all patients require a detailed history, examination and, investigations.Methods: This is a cross sectional comparative study of 50 patients having symptoms of necrotizing fasciitis to be divided into two groups of 25 patients each where one group is having diabetes mellitus and other group without diabetes mellitus.Results: Diabetes mellitus patients have more morbidity and mortality in term of more days of hospital stay, rate of amputations and number of debridements. Early diagnosis and early aggressive debridement is the mainstay of management. Aggressive surgical debridement at initial stages of presentation can halt the clinical process and patient can have better prognosis. In neglected diabetic patient’s debridement alone is not sufficient and amputation may be required in some cases.  Conclusions: Early diagnosis and aggressive debridement in necrotizing fasciitis patients results in better outcomes.  

scholarly journals Concurrent Pseudomonas Periorbital Necrotizing Fasciitis and Endophthalmitis: A Case Report and Literature Review

Pathogens ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 854
Author(s):  
Yu-Kuei Lee ◽  
Chun-Chieh Lai
Keyword(s):  
Soft Tissue ◽  
Literature Review ◽  
Necrotizing Fasciitis ◽  
Subcutaneous Tissue ◽  
Superficial Fascia ◽  
Upper Eyelid ◽  
Case Presentation ◽  
Phthisis Bulbi ◽  
Eyelid Swelling ◽  
The Rich

(1) Background: Necrotizing fasciitis (NF) is an infection involving the superficial fascia and subcutaneous tissue. Endophthalmitis is an infection within the ocular ball. Herein we report a rare case of concurrent periorbital NF and endophthalmitis, caused by Pseudomonas aeruginosa (PA). We also conducted a literature review related to periorbital PA skin and soft-tissue infections. (2) Case presentation: A 62-year-old male had left upper eyelid swelling and redness; orbital cellulitis was diagnosed. During eyelid debridement, NF with the involvement of the upper Müller’s muscle and levator muscle was noted. The infection soon progressed to scleral ulcers and endophthalmitis. The eye developed phthisis bulbi, despite treatment with intravitreal antibiotics. (3) Conclusions: Immunocompromised individuals are more likely than immunocompetent hosts to be infected by PA. Although periorbital NF is uncommon due to the rich blood supply in the area, the possibility of PA infection should be considered in concurrent periorbital soft-tissue infection and endophthalmitis.

scholarly journals Necrotizing Fasciitis in Neonate and Use of Allograft

2019 ◽  
Vol 8 (1) ◽  
pp. 8
Author(s):  
Nitinkumar Borkar ◽  
Phalguni Padhi ◽  
Jiten Kumar Mishra ◽  
Shamendra Anand Sahu ◽  
Debajyoti Mohanty ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Skin Graft ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Subcutaneous Fat ◽  
Surgical Debridement ◽  
Split Thickness Skin Graft ◽  
Superficial Fascia ◽  
Thickness Skin

Necrotising fasciitis is a fulminant and rapidly progressive infection of the superficial fascia and subcutaneous tissue. It is rare in newborn. Trunk is the commonest site of involvement in newborns. Early diagnosis and prompt surgical debridement is the preferred treatment. Debridement in NF leads to a large raw area which may not heal by primary intention and may a split thickness skin graft for healing. Presence of minimum subcutaneous fat, loose skin and large raw area at donor site like back in some neonate poses difficulty for harvesting of skin graft. In such neonates allograft make a valuable option temporarily. Herein we report a case of a neonate with NF in whom post debridement raw area was covered with allograft from mother.

Necrotizing Fasciitis: Myalgia Is Diagnostic? A Case Series and Literature Review

2020 ◽  
pp. 153473462095860
Author(s):  
Sachin Teelucksingh ◽  
Vijai Deonarine ◽  
Shariful Islam ◽  
Shamir O’Cawich ◽  
Dave Harnanan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Subcutaneous Tissue ◽  
Case Series ◽  
Muscular Activity ◽  
Clinical Suspicion ◽  
Prompt Treatment ◽  
Diagnostic Difficulties ◽  
Radiologic Features

Necrotizing fasciitis, commonly known as “flesh-eating disease,” is an aggressive soft tissue infection that destroys the fascia, subcutaneous tissue, and skin. Specific clinical features (crepitus or radiologic features of gas in tissues) either appear late or are of poor sensitivity. Thus, a high index of clinical suspicion is required for early diagnosis and prompt treatment, which are the best methods of minimizing its high associated morbidity and mortality. We present 3 cases to demonstrate diagnostic difficulties and challenges in management and highlight the feature of pain on muscular activity.

scholarly journals Necrotizing Fasciitis: A Review of Management Guidelines in a Large Obstetrics and Gynecology Teaching Hospital

1993 ◽  
Vol 1 (1) ◽  
pp. 16-22 ◽  
Author(s):  
C. D. Thompson ◽  
A. L. Brekken ◽  
W. H. Kutteh
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Operating Room ◽  
Teaching Hospital ◽  
Subcutaneous Tissue ◽  
Diabetic Woman ◽  
Wound Complications ◽  
Morbidly Obese ◽  
Superficial Fascia

Necrotizing fasciitis is a severe, life-threatening soft tissue infection that results in rapid and progressive destruction of the superficial fascia and subcutaneous tissue. Because of its varied clinical presentation and bacteriological make-up, it has been labelled with many other names such as acute streptococcal gangrene, gangrenous erysipelas, necrotizing erysipelas, hospital gangrene, and acute dermal gangrene. Although described by Hippocrates and Galen, it has received increasing attention in obstetrical and gynecological literature only within the last 20 years. This review includes two recent cases successfully managed at Parkland Memorial Hospital, Dallas, Texas. The first patient was a 50 year old, morbidly obese, diabetic woman who presented with a small, painful lesion on the vulva. After failing triple antibiotic therapy with ampicillin, clindamycin, and gentamicin, the diagnosis of necrotizing fasciitis of the vulva was made, and she was taken to the operating room for extensive excision. She was discharged home on hospital day 29. The second patient was a 65 year old, obese, diabetic woman with risk factors for atherosclerosis who had a wound separation after an abdominal hysterectomy. Two days later a loss of resistance to probing was noted in the subcutaneous tissue. Necrotizing fasciitis was suspected, and she was taken to the operating room for resection. The patient was discharged home on hospital day 27. The mortality rate after diagnosis of necrotizing fasciitis has been reported to be 30% to 60%. We review the literature and outline the guidelines used in a large Ob/Gyn teaching hospital to minimize the adverse outcome. Lectures on soft-tissue infections are included on a regular basis. The high-risk factors of age over 50, diabetes, and atherosclerosis are emphasized. The need for early diagnosis and surgical treatment within 48 hours is stressed, and any suspicious lesions or wound complications are reported to experienced senior house officers and staff. We use two recent cases to highlight the diagnostic clues and management strategies for this often fatal polymicrobial infection.

scholarly journals Necrotizing Fasciitis: a Clinical Case and a Review of the Literature

2020 ◽  
Vol 12 (4) ◽  
pp. 141-146
Author(s):  
Ivanka Danchova Temelkova ◽  
Yordan Stoyanov Milev ◽  
Zhasmina Krasimirova Garkova ◽  
Tsveta Ivanova Kalinova ◽  
Zhenya Krasimirova Dimitrova ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Severe Pain ◽  
Clinical Case ◽  
Subcutaneous Tissue ◽  
Good Prognosis ◽  
Review Of The Literature ◽  
Fatal Course ◽  
Life Threatening

Abstract Necrotizing fasciitis is a soft tissue, life-threatening infection with a fulminant and often fatal course. Early diagnosis is usually delayed as the onset of the disease is often masked in the form of erysipelas or cellulite. The condition is characterized by necrosis of the skin, subcutaneous tissue and underlying fascia. We describe a case of a 42-year-old man with a complaint of erythema, fever and severe pain in his right leg 4 days before hospitalization. The patient was admitted and treated with a diagnosis of erysipelas. A few hours after admission, in connection with a drastic deterioration in the general condition and dermatological status, he was transferred to a purulentseptic ward with a fulminant picture of necrotizing fasciitis. Debridement and fasciotomy were performed successfully and timely. Good prognosis and survival in patients with NF correlate directly with the complex of measures. Appropriate antibiotics and intensive general support avoid massive systemic diffusion. Early and adequate surgical debridement and fasciotomy are associated with improved survival.

scholarly journals Pyelonephritis can be a source of a life threatening necrotizing myofasciitis

2014 ◽  
Vol 8 (5-6) ◽  
pp. 462
Author(s):  
Haytham Kamel ◽  
Mohamed Soliman Edris Awed ◽  
Ahmed Fouad Kotb
Keyword(s):  
Necrotizing Fasciitis ◽  
Adult Male ◽  
Soft Tissues ◽  
Subcutaneous Tissue ◽  
Relevant Literature ◽  
Deep Fascia ◽  
Necrotizing Myositis ◽  
Life Threatening

Necrotizing fasciitis is a progressive, rapidly spreading, inflammatory infection located in deep fascia. It may cause necrosis of skin and subcutaneous tissue and can even result in involvement of adjacent soft tissues such as muscles resulting in necrotizing myositis. We report the case of an adult male presenting with necrotizing myofasciitis secondary to left pyelonephritis. We also review the relevant literature.

scholarly journals Klebsiella Pneumoniae Necrotizing Fascitis of The Lower Extremity in A 7-Month-Old Male: A Case Report and Literature Review

2021 ◽  
Vol 4 (2) ◽  
pp. 52
Author(s):  
Marelno Zakanito ◽  
Iswinarno Saputro
Keyword(s):  
Soft Tissue ◽  
Klebsiella Pneumoniae ◽  
Lower Extremity ◽  
Necrotizing Fasciitis ◽  
Subcutaneous Tissue ◽  
Initial Period ◽  
Academic Medical Center ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Laboratory Evaluation

Introduction: Klebsiella pneumoniae necrotizing fasciitis is an uncommon soft tissue infection characterized by rapidly progressing necrosis involving the skin, subcutaneous tissue, and fascia. This condition may result in gross morbidity and mortality if not treated in its early stages. In fact, the mortality rate of this condition is high, ranging from 25 to 35%. We present a case of 7-month-old male with K. pneumoniae necrotizing fasciitis of the lower extremity. Materials and Methods: A 7-month-old male presented with large areas over both left and right inferior side of the lower limbs to the emergency department of Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Physical examination revealed elevated heart rate of 136 times per minute and increased body temperature of 38oC. The large areas on both lower limbs were darkened, sloughed off, and very tender to palpation. A small area over the right hand was erythematous and sloughed off. Laboratory evaluation demonstrated decreased hemoglobin of 6.2 g/dL and elevated leukocyte of 28,850 g/dL. Blood cultures demonstrated that K. pneumoniae was present. Discussion: NF is usually hard to diagnose during the initial period. The findings of NF can overlap with other soft tissue infections including cellulitis, abscess or even compartment syndrome. However, pain out of proportion to the degree of skin involvement and signs of systemic shock should alert the clinical to the possibility of NF. The clinical manifestations of NF start around a week after the initiating event, with induration and edema, followed by 24 to 48 hours later by erythema or purple discoloration and increasing local fever In the next 48 to 72 hours, the skin turns smooth, bright, and serous, or hemorrhagic blisters develop. If unproperly treated, necrosis develops, and by the fifth or sixth day, the lesion turns black with a necrotic crust. Conclusions: K. pneumoniae necrotizing fasciitis is a rare but lifethreatening disease. A high index of suspicion is required for early diagnosis and treatment of this condition

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