scholarly journals Massive necrotizing fasciitis following bellow-knee arterial surgery: A therapeutic challenge

2015 ◽  
Vol 72 (5) ◽  
pp. 469-472
Author(s):  
Petar Popov ◽  
Slobodan Tanaskovic ◽  
Vuk Sotirovic ◽  
Dragoslav Nenezic ◽  
Djordje Radak
Keyword(s):  
Necrotizing Fasciitis ◽  
Wide Spectrum ◽  
Clinical Signs ◽  
Systemic Infection ◽  
Surgical Debridement ◽  
Bypass Grafting ◽  
Superficial Fascia ◽  
Wound Swab ◽  
Life Threatening ◽  
Skin Reconstruction

Introduction. Necrotizing fasciitis is a rare, progressive bacterial infection of superficial fascia followed by secondary subcutaneous tissue necrosis. We pressented a patient with massive fulminant lifethreatening necrotising fasciitis after bellow-knee femoro-popliteal vein bypass grafting successfully treated by antibiotics, surgical debridement and final skin reconstruction using the Tierch method. Case report. A 61-year-old patient was ad-mitted to the Vascular Surgery Clinic for below-knee femoro-popliteal bypass grafting. He complained of intermittent claudication in the left leg after 50 m, ankle brachial indexes were 0.45 on the left and 1.0 on the right side. Femoropopliteal below-knee bypass grafting was done using the autologous great saphenous vein. In the very next day, initial signs of skin infection appeared including local inflammation, erythema, swelling and cellulitis restricted to saphenectomy site. These changes had rapidly spread in the following days on the deep tissue of the whole upper and lower leg, including the groin and with clinical signs of life-threatening systemic infection. Immediate surgical debridement was done followed by extensive wound packing and wide spectrum antibiotics administration for the next 33 days when final skin reconstruction by the Tierch method was performed. Interesting point is that this entire time wound swab was sterile. Conclusion. In the presented case immediate surgical debridement, wide spectrum antibiotics administration and consistent wound packing gave satisfactory results in this life-threatening systemic infection. Wound swab is not always a reliable indicator of the infection while clinical findings and surgeons? experience are of great significance in rapid reaction to this rare surgical complication.

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.

scholarly journals Diagnosis and management of necrotizing fasciitis in the light of the recent recommendations

2019 ◽  
Vol 41 part 1 (2) ◽  
pp. 77-84
Author(s):  
C. O. Kosulnikov ◽  
V. N. Lisnichaya ◽  
A. M. Besedin ◽  
S. І. Karpenko ◽  
S. A. Tarnopolsky ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Soft Tissues ◽  
Subcutaneous Fat ◽  
Surgical Debridement ◽  
Type I ◽  
Cause Of Deaths ◽  
Life Threatening ◽  
Management Modality ◽  
Closure Method ◽  
Primary Management

Summary: Necrotizing fasciitis is a rare but life-threatening infection of the soft tissues. It is characterized by spreading inflammation and necrosis starting from the fascia, muscles, and subcutaneous fat, with subsequent necrosis of the overlying skin. Necrotizing fasciitis is classified into four types, depending on microbiological findings. The diagnosis of this disease is difficult. Late diagnosis is observed in 85–100% of cases and is considered the only cause of deaths. Emergency surgical debridement is the primary management modality for necrotizing fasciitis. Vacuum assisted closure therapy is fast and effective wound closure method. Antibiotics and surgical debridement play a key role in the treatment of necrotizing fasciitis.In our hospital, there were 75 patients with necrotizing fasciitis in the last 5 years (type I – 92%, type II – 8%). We observed localization of necrotizing fasciitis in the perineum (32%), upper extremities and chest (25%), lower extremities (28%), abdominal wall and retroperitoneal space (15%). Mortality was 9,5%. Keywords: necrotizing fasciitis, sepsis, surgical debridement.

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 Fulminant necrotizing fasciitis of the thigh, following an infection of the sacro-iliac joint in an immunosuppressed, young woman

2015 ◽  
Vol 7 (3) ◽  
Author(s):  
Martin Gothner ◽  
Marcel Dudda ◽  
Christiane Kruppa ◽  
Thomas A. Schildhauer ◽  
Justyna Swol
Keyword(s):  
Drug Abuse ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Rare Complication ◽  
Good Condition ◽  
Surgical Debridement ◽  
Soft Tissue Coverage ◽  
Immunosuppressed Patients ◽  
Life Threatening ◽  
Split Skin

Necrotizing soft tissue infection of an extremity is a rare but life-threatening disease. The disease is an infection that involves the soft tissue layer and is characterized by rapidly spreading inflammation (especially of the fascial planes and the surrounding tissues) with a high mortality. Early diagnosis is essential for the outcome of the patients. Radical surgical debridement is the treatment of choice. The predisposing factors are immunosuppression, diabetes mellitus and drug abuse. This report presents a case of necrotizing fasciitis in the thigh, following an abscess of the sacro-iliac joint, as a rare complication in a young, immunosuppressed woman. The patient’s history revealed intra-venous drug abuse and hepatitis C. After immediate diagnosis by magnetic resonance imaging, radical surgical debridement was required and performed. Prior to soft tissue coverage with a split skin graft, five additional sequential debridements were necessary. During her hospital stay, the patient experienced further cerebral and pulmonary septic embolisms and an infection of the elbow. Six months after admission, the patient was discharged in good condition to a rehabilitation center. Necrotizing fasciitis is a life-threatening complication following an abscess of the sacro-iliac joint. Physicians must be vigilant to inflammatory signs and pain in immunosuppressed patients. An abscess of the sacro-iliac joint is rare, but complications of an untreated abscess can be fatal in these patients.

Cervical necrotizing fasciitis and tonsillitis

1994 ◽  
Vol 108 (5) ◽  
pp. 435-437 ◽  
Author(s):  
P. M. J. Scott ◽  
R. S. Dhillion ◽  
P. J. McDonald
Keyword(s):  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Clinical Signs ◽  
Surgical Debridement ◽  
Healthy Man

AbstractWe present a case of cervical necrotizing fasciitis following quinsy in a previously fit and healthy man. This is a potentially fatal condition with few specific clinical signs that requires early diagnosis and surgical debridement. Other features of the disease are discussed.

scholarly journals Necrotizing fasciitis of head – neck

1970 ◽  
Vol 14 (1) ◽  
pp. 9-14
Author(s):  
Sudhangshu Shekhar Biswas ◽  
Zaheer Al-Amin
Keyword(s):  
Antibiotic Therapy ◽  
Necrotizing Fasciitis ◽  
Primary Source ◽  
Good Control ◽  
Surgical Debridement ◽  
Electrolyte Imbalance ◽  
Diabetic Patients ◽  
Source Of Infection ◽  
Life Threatening ◽  
Head Neck

Necrotizing Fasciitis of head -neck is not so uncommon in diabetic patients which is a progressive, destructive and potentially life threatening soft tissue infection primarily affecting superficial fascial planes. It is caused by group A streptococci or by a synergistic combination of aerobe and anaerobe micro organisms. This is a retrospective study which makes an attempt to analyze various parameters such as demography, aetiology, complications, and management methods determining the overall prognosis. Odontogenic infection was the primary source of infection. Diabetes, anaemia, chronic renal failure and electrolyte imbalance were the most commonly associated illness. Surgical debridement with combined antibiotic therapy was used in the management of necrotizing fasciitis along with good control of diabetes and correction of anaemia and electrolyte imbalances. Overall mortality was low. The late referral and associated complications had increased the hospital stay. With proper control of infection by early diagnosis, surgical debridement and combined antibiotic therapy, along with timely control of complications and associated illness - better results can be possible. Key words: necrotizing fasciitis, antibiotics, debridement  DOI: 10.3329/bjo.v14i1.3274 Bangladesh J of Otorhinolaryngology 2008; 14(1) : 9-14

scholarly journals Necrotising fascitis - a life-threatening infection: Case reports and literature review

2021 ◽  
pp. 23-23
Author(s):  
Dzemail Detanac ◽  
Mehmed Mujdragic ◽  
Dzenana Detanac ◽  
Mersudin Mulic ◽  
Hana Mujdragic
Keyword(s):  
Necrotizing Fasciitis ◽  
Case Reports ◽  
Perianal Fistula ◽  
Severe Infection ◽  
Deep Infection ◽  
Superficial Fascia ◽  
Treatment Measures ◽  
Mortality Case ◽  
Life Threatening ◽  
Infection Source

Introduction. Necrotizing Fasciitis is a rare, severe, aggressive infection, life-threatening surgical emergency that spreads quickly, characterized by extensive necrosis of the deep and superficial fascia, associated with significant morbidity and mortality. Case outline. We are presenting two case reports with Necrotizing Fasciitis: a 54-year-old male patient, obese, with hypertension and untreated perianal fistula with severe infection of perianal region, perineum and scrotum, and 64-year-old female patient with diabetes mellitus and heart disease, with severe infection of the lower extremity, anterior abdominal wall, inguinal and gluteal region, in which the entry point of infection were microlesions of the skin after shaving. Both patients were treated by emergency extensive surgical necrectomy with eradication of the deep infection source, with all conservative treatment measures. The first patient was treated with hyperbaric oxygen therapy, the 2nd wasn't because of cardiac and pulmonary contraindications. Conclusion. Better treatment outcome requires a multidisciplinary approach (cardiologist, endocrinologist, nephrologist, orthopedist, surgeon). Rapid and extensive surgical necrectomy is necessary to increase the success of the treatment of patients with this infection.

scholarly journals Cervical Necrotizing Fasciitis, Diagnosis and Treatment of a Rare Life-Threatening Infection

2021 ◽  
pp. 014556132199134
Author(s):  
Jack Hua ◽  
Paul Friedlander
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Definitive Diagnosis ◽  
Clinical Suspicion ◽  
Plain Radiography ◽  
Surgical Debridement ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections ◽  
Life Threatening ◽  
Fat Stranding

Importance: Necrotizing fasciitis is a relatively uncommon and potentially life-threatening soft tissue infection, with morbidity and mortality approaching 25% to 35%, even with optimal treatment. The challenge of diagnosis for necrotizing soft tissue infections (NSTIs) is their rarity, with the incidence of approximately 1000 cases annually in the United States. Given the rapid progression of disease and its similar presentation to more benign processes, early and definitive diagnosis is imperative. Findings: Signs and symptoms of NSTIs in the early stages are virtually indistinguishable from those seen with abscesses and cellulitis, making definitive diagnosis difficult. The clinical presentation will depend on the pathogen and its virulence factors which ultimately determine the area and depth of invasion into tissue. There are multiple laboratory value scoring systems that have been developed to support the diagnosis of an NSTI. The scoring system with the highest positive (92%) and negative (96%) predictive value is the laboratory risk indicator for necrotizing fasciitis (LRINEC). The score is determined by 6 serologic markers: C-reactive protein (CRP), total white blood cell (WBC) count, hemoglobin, sodium, creatinine, and glucose. A score ≥ 6 is a relatively specific indicator of necrotizing fasciitis (specificity 83.8%), but a score <6 is not sensitive (59.2%) enough to rule out necrotizing fasciitis. In terms of imaging, computed tomography (CT) imaging, while more sensitive (80%) than plain radiography in detecting abnormalities, is just as nonspecific. Computed tomography imaging of NSTIs demonstrates fascial thickening (with potential fat stranding), edema, subcutaneous gas, and abscess formation. Magnetic resonance imaging (MRI) has demonstrated sensitivity of 100% and specificity of 86%, though MRI may not show early cases of fascial involvement of necrotizing fasciitis. Conclusions and Relevance: Necrotizing soft tissue infections are rapidly progressive and potentially fatal infections that require a high index of clinical suspicion to promptly diagnose and aggressive surgical debridement of affected tissue in order to ensure optimal outcomes. Prompt surgical and infectious disease consultation is necessary for the treatment and management of these patients. While imaging is useful for further characterization, it should not delay surgical consultation. Necrotizing soft tissue infection remains a clinical diagnosis, although plain radiography, CT imaging, and ultrasound can provide useful clues. In general, the management of these patients should include rapid diagnosis, using a combination of clinical suspicion, laboratory data (LRINEC score), and imaging (MRI being the recommended imaging modality), prompt infectious disease and surgical consultation, surgical debridement, and delayed reconstruction. Laboratory findings that can more strongly suggest a diagnosis of NSTI include elevated CRP, elevated WBC, low hemoglobin, decreased sodium, and increased creatinine. Imaging findings include fascial thickening (with potential fat stranding), edema, subcutaneous gas, and abscess formation. Broad-spectrum antibiotics should be started in all cases of suspected NSTI. Surgical debridement, however, remains the lynchpin for treatment of cervical necrotizing fasciitis.

scholarly journals 187 Improving Awareness of Managing Post-Operative Haemorrhage in Patients Undergoing Thyroid and Parathyroid Surgery: The SCOOP Protocol

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Bhattacharya ◽  
J Jegadeeson ◽  
J Ramsingh ◽  
P Truran
Keyword(s):  
Nursing Staff ◽  
Simulation Training ◽  
Clinical Signs ◽  
Skin Wound ◽  
Junior Doctors ◽  
Parathyroid Surgery ◽  
Surgical Department ◽  
Life Threatening ◽  
Clinical Questions ◽  
Life Threatening Complication

Abstract Introduction Post-operative haemorrhage is a rare but potentially life-threatening complication of thyroid surgery and occurs in 1 in 100 patients. Our aim was to assess current levels of awareness of post-operative haemorrhage in the surgical department and to improve confidence in managing this. Method Questionnaires with a combination of clinical questions were distributed amongst nurses, foundation doctors, senior house officers and registrars in the surgical department. Results There was a clear gap in awareness in all grades. The British Association of Endocrine and Thyroid surgeons (BAETS) have guidance on the management of these patients and in particular the acronym SCOOP (Steristrips removed, Cut subcuticular sutures, Open skin wound, Open strap muscles, Pack wound). 18/24 of participants had not heard of the SCOOP protocol. Most nurses (6/12) all junior doctors (8/8) showed lack of confidence in managing patients with suspected bleeding. Conclusions An informative poster was created for relevant clinical areas as per the BAETS recommendation. These posters outlined the steps in the SCOOP acronymas well as the main clinical signs of haemorrhage. BAETS recommend that all first responders, including nursing staff, junior doctors and the crash team should be aware of the SCOOP protocol. Simulation training sessions are in progress for these members of staff.

scholarly journals Many faces of acute bowel ischemia: overview of radiologic staging

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Amir H. Davarpanah ◽  
Afshar Ghamari Khameneh ◽  
Bardia Khosravi ◽  
Ali Mir ◽  
Hiva Saffar ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Bowel Ischemia ◽  
Management Approach ◽  
Final Decision ◽  
Imaging Findings ◽  
Life Threatening ◽  
Imaging Signs ◽  
Late Stages ◽  
Underlying Pathophysiology ◽  
Made In

AbstractAcute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient’s management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.

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